Healthcare Provider Details

I. General information

NPI: 1609105188
Provider Name (Legal Business Name): MALA K. TANDON PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2009
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11350 RANDOM HILLS RD STE 520
FAIRFAX VA
22030-7428
US

IV. Provider business mailing address

5921 HALL ST
SPRINGFIELD VA
22152-1402
US

V. Phone/Fax

Practice location:
  • Phone: 571-332-9095
  • Fax: 703-644-6237
Mailing address:
  • Phone: 571-332-9095
  • Fax: 703-644-6237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number0810004632
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number0810004632
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number0810004632
License Number StateVA
# 5
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810004632
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: