Healthcare Provider Details

I. General information

NPI: 1528145547
Provider Name (Legal Business Name): AZHAR ABU-ALI PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W BROAD ST STE 305
FALLS CHURCH VA
22046-3220
US

IV. Provider business mailing address

701 W BROAD ST STE 305
FALLS CHURCH VA
22046-3220
US

V. Phone/Fax

Practice location:
  • Phone: 703-533-3302
  • Fax: 703-237-2083
Mailing address:
  • Phone: 703-533-3302
  • Fax: 703-237-2083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810003616
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: