Healthcare Provider Details

I. General information

NPI: 1538266192
Provider Name (Legal Business Name): AARON B MEKHOUBAT PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 07/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10106 KRAUSE RD
CHESTERFIELD VA
23832-6572
US

IV. Provider business mailing address

PO BOX 2215
CHESTERFIELD VA
23832-9112
US

V. Phone/Fax

Practice location:
  • Phone: 804-717-5419
  • Fax: 804-520-8595
Mailing address:
  • Phone: 804-717-5419
  • Fax: 804-520-8595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701002361
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0717000051
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: