Healthcare Provider Details

I. General information

NPI: 1568222784
Provider Name (Legal Business Name): NIDHI KHANNA M.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2024
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20098 ASHBROOK PL STE 255
ASHBURN VA
20147-3394
US

IV. Provider business mailing address

14712 BASINGSTOKE LOOP
CENTREVILLE VA
20120-3119
US

V. Phone/Fax

Practice location:
  • Phone: 804-207-6737
  • Fax:
Mailing address:
  • Phone: 609-933-1055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0704015992
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: