Healthcare Provider Details

I. General information

NPI: 1437021417
Provider Name (Legal Business Name): DANA JUNE BLADES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2025
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N WASHINGTON ST STE 102G
FALLS CHURCH VA
22046-3441
US

IV. Provider business mailing address

5851 COLUMBIA PIKE APT 559
FALLS CHURCH VA
22041-2080
US

V. Phone/Fax

Practice location:
  • Phone: 703-923-8965
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810009464
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: