Healthcare Provider Details

I. General information

NPI: 1699682997
Provider Name (Legal Business Name): ELLEN ABOOD MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10340 DEMOCRACY LN STE 203
FAIRFAX VA
22030-2518
US

IV. Provider business mailing address

1737 W BRADDOCK PL
ALEXANDRIA VA
22302-2643
US

V. Phone/Fax

Practice location:
  • Phone: 571-367-9951
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number0911000051
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: