Healthcare Provider Details

I. General information

NPI: 1154075331
Provider Name (Legal Business Name): SCOTT PSYCHOLOGICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2022
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 GREENSBORO DR STE 550
MC LEAN VA
22102-5146
US

IV. Provider business mailing address

12332 TOWNCENTER PLZ # 628
STERLING VA
20164-7045
US

V. Phone/Fax

Practice location:
  • Phone: 240-444-0554
  • Fax:
Mailing address:
  • Phone: 240-444-0554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ARIANNA SCOTT
Title or Position: OWNER
Credential:
Phone: 240-444-0554