Healthcare Provider Details

I. General information

NPI: 1073188306
Provider Name (Legal Business Name): DENISE COLTSON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DENISE FEDLAN

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 02/19/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8221 WILLOW OAKS CORPORATE DR STE 4-425
FAIRFAX VA
22031-4512
US

IV. Provider business mailing address

8221 WILLOW OAKS CORPORATE DR STE 4-425
FAIRFAX VA
22031-4512
US

V. Phone/Fax

Practice location:
  • Phone: 703-289-7599
  • Fax: 703-289-4612
Mailing address:
  • Phone: 703-289-7599
  • Fax: 703-289-4612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0810008091
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: