Healthcare Provider Details

I. General information

NPI: 1013717727
Provider Name (Legal Business Name): DEATRA IDLET-BATTLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2025
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5980 MEERES RD
FORT BELVOIR VA
22060-3270
US

IV. Provider business mailing address

8270 WILLOW OAKS CORPORATE DR
FAIRFAX VA
22031-4530
US

V. Phone/Fax

Practice location:
  • Phone: 703-781-2735
  • Fax:
Mailing address:
  • Phone: 703-781-2735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberPGP-0685736
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: