Healthcare Provider Details

I. General information

NPI: 1124829056
Provider Name (Legal Business Name): PRECISION NEUROPSYCHOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1464 INGLESIDE AVE
MC LEAN VA
22101-3709
US

IV. Provider business mailing address

1390 CHAIN BRIDGE RD # 85
MC LEAN VA
22101-3904
US

V. Phone/Fax

Practice location:
  • Phone: 703-957-7300
  • Fax:
Mailing address:
  • Phone: 703-957-7300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JONATHAN DERIGHT
Title or Position: PRESIDENT
Credential: PHD
Phone: 703-957-7300