Healthcare Provider Details

I. General information

NPI: 1861008492
Provider Name (Legal Business Name): NICOLE N HASHEMIAN PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 09/18/2020
Certification Date: 09/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3040 WILLIAMS DR STE 402
FAIRFAX VA
22031-4618
US

IV. Provider business mailing address

3040 WILLIAMS DR STE 402
FAIRFAX VA
22031-4618
US

V. Phone/Fax

Practice location:
  • Phone: 703-573-3673
  • Fax: 703-573-3574
Mailing address:
  • Phone: 703-573-3673
  • Fax: 703-573-3574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number0810007227
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: