Healthcare Provider Details

I. General information

NPI: 1992893176
Provider Name (Legal Business Name): AMY EBEID PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10805 MAIN ST STE 500
FAIRFAX VA
22030-4747
US

IV. Provider business mailing address

10805 MAIN ST STE 500
FAIRFAX VA
22030-4747
US

V. Phone/Fax

Practice location:
  • Phone: 703-798-6358
  • Fax:
Mailing address:
  • Phone: 703-798-6258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810003667
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: