Healthcare Provider Details

I. General information

NPI: 1720316755
Provider Name (Legal Business Name): COGNITIVE SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2009
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 EATON PL STE 225
FAIRFAX VA
22030-2210
US

IV. Provider business mailing address

1025 THOMAS JEFFERSON ST. NW SUITE 420 EAST
WASHINGTON DC
20007
US

V. Phone/Fax

Practice location:
  • Phone: 202-903-4763
  • Fax: 202-333-0366
Mailing address:
  • Phone: 202-903-4763
  • Fax: 202-333-0366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1000591
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHANIE RENEE JOHNSON
Title or Position: OWNER
Credential: PHD
Phone: 202-903-4763