Healthcare Provider Details

I. General information

NPI: 1235175068
Provider Name (Legal Business Name): MARY MOORE ARLEDGE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4041 UNIVERSITY DR STE 200
FAIRFAX VA
22030-3410
US

IV. Provider business mailing address

4041 UNIVERSITY DR STE 200
FAIRFAX VA
22030-3410
US

V. Phone/Fax

Practice location:
  • Phone: 202-760-1998
  • Fax:
Mailing address:
  • Phone: 202-760-1998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0701002764
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: