Healthcare Provider Details

I. General information

NPI: 1649280249
Provider Name (Legal Business Name): LOUISE GABRIELLE ROY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 W. GREAT FALLS ST. SUITE 101
FALLS CHURCH VA
22046-3402
US

IV. Provider business mailing address

131 W. GREAT FALLS ST. SUITE 101
FALLS CHURCH VA
22046-3402
US

V. Phone/Fax

Practice location:
  • Phone: 703-798-5186
  • Fax: 202-558-2157
Mailing address:
  • Phone: 703-798-5186
  • Fax: 301-576-5173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 1689
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810002170
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810-002170
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: