Healthcare Provider Details

I. General information

NPI: 1982792917
Provider Name (Legal Business Name): NEW HORIZONS PSYCHOLOGICAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5045 BACKLICK ROAD
ANNANDALE VA
22003-6045
US

IV. Provider business mailing address

5045 BACKLICK ROAD
ANNANDALE VA
22003-6045
US

V. Phone/Fax

Practice location:
  • Phone: 703-914-1082
  • Fax: 703-914-3920
Mailing address:
  • Phone: 703-914-1082
  • Fax: 703-914-3920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. BONNIE LEE BRYANT
Title or Position: PRACTICE DIRECTOR
Credential: PH.D.
Phone: 301-292-3994