Healthcare Provider Details

I. General information

NPI: 1699806026
Provider Name (Legal Business Name): GARY SPIVACK DBA COLUMBIA ASSOCIATES IN PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N GLEBE RD SUITE 303
ARLINGTON VA
22207-3558
US

IV. Provider business mailing address

2501 N GLEBE RD 303
ARLINGTON VA
22207-3558
US

V. Phone/Fax

Practice location:
  • Phone: 703-841-1290
  • Fax: 703-841-1315
Mailing address:
  • Phone: 703-841-1290
  • Fax: 703-841-1315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateVA

VIII. Authorized Official

Name: MS. LAUREN S. SHEEHAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 703-841-1290