Healthcare Provider Details

I. General information

NPI: 1669983128
Provider Name (Legal Business Name): NEUROSCIENCE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2017
Last Update Date: 10/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 ELDEN ST STE 17
HERNDON VA
20170-4840
US

IV. Provider business mailing address

106 ELDEN ST STE 17
HERNDON VA
20170-4840
US

V. Phone/Fax

Practice location:
  • Phone: 703-787-9090
  • Fax: 703-787-8845
Mailing address:
  • Phone: 703-787-9090
  • Fax: 703-787-8845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. MELISSA ANDREWS
Title or Position: VICE PRESIDENT
Credential:
Phone: 703-787-9090