Healthcare Provider Details

I. General information

NPI: 1124573803
Provider Name (Legal Business Name): HAYLEY O'BRIEN M.A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2016
Last Update Date: 08/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 WILSON BLVD SUITE 412
ARLINGTON VA
22201-3397
US

IV. Provider business mailing address

1512 S ARLINGTON RIDGE RD APT 205
ARLINGTON VA
22202-1955
US

V. Phone/Fax

Practice location:
  • Phone: 571-328-7408
  • Fax: 844-249-5577
Mailing address:
  • Phone: 845-558-9472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: