Healthcare Provider Details

I. General information

NPI: 1144389156
Provider Name (Legal Business Name): VICTORIA J BALENGER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1485 CHAIN BRIDGE RD STE 203
MCLEAN VA
22101-4511
US

IV. Provider business mailing address

9508 PAGE AVE
BETHESDA MD
20814-1736
US

V. Phone/Fax

Practice location:
  • Phone: 703-909-6806
  • Fax:
Mailing address:
  • Phone: 301-897-0871
  • Fax: 301-415-1226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number0810-002414
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number657732
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: