Healthcare Provider Details

I. General information

NPI: 1053795583
Provider Name (Legal Business Name): MARIA HOVANDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2015
Last Update Date: 07/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5860 NICOTINE TRL
LORTON VA
22079-4265
US

IV. Provider business mailing address

5860 NICOTINE TRL
LORTON VA
22079-4265
US

V. Phone/Fax

Practice location:
  • Phone: 703-399-4388
  • Fax:
Mailing address:
  • Phone: 703-399-4388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1034000116
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: