Healthcare Provider Details

I. General information

NPI: 1245922178
Provider Name (Legal Business Name): BRIANNA LA NYCE ECTOR PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 05/22/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10513 JUDICIAL DR STE 301
FAIRFAX VA
22030-7528
US

IV. Provider business mailing address

6212 LES DORSON LN
ALEXANDRIA VA
22315-3228
US

V. Phone/Fax

Practice location:
  • Phone: 703-966-5173
  • Fax:
Mailing address:
  • Phone: 571-221-7048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810008176
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: