Healthcare Provider Details

I. General information

NPI: 1629599154
Provider Name (Legal Business Name): ALLANNAH DEAHL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2017
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

994 SOWDER VILLAGE SQUARE #102
MANASSAS VA
20109-5464
US

IV. Provider business mailing address

231 COBBLE STONE DR
WINCHESTER VA
22602-6871
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax:
Mailing address:
  • Phone: 571-919-5719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133004660
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: