Healthcare Provider Details

I. General information

NPI: 1376172353
Provider Name (Legal Business Name): ERIKA PRUETT PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11204 WAPLES MILL RD
FAIRFAX VA
22030-6036
US

IV. Provider business mailing address

11204 WAPLES MILL RD
FAIRFAX VA
22030-6036
US

V. Phone/Fax

Practice location:
  • Phone: 703-218-8500
  • Fax: 703-359-0463
Mailing address:
  • Phone: 703-218-8500
  • Fax: 703-359-0463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0810008170
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: