Healthcare Provider Details

I. General information

NPI: 1730896606
Provider Name (Legal Business Name): AYSE SELIN IKIZLER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2022
Last Update Date: 11/01/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 FAIRFAX DR STE 205
ARLINGTON VA
22203-1622
US

IV. Provider business mailing address

4401 FAIRFAX DR STE 205
ARLINGTON VA
22203-1622
US

V. Phone/Fax

Practice location:
  • Phone: 571-328-7408
  • Fax:
Mailing address:
  • Phone: 571-328-7408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810007976
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: