Healthcare Provider Details

I. General information

NPI: 1558279687
Provider Name (Legal Business Name): BARRY VASSAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12020 SUNRISE VALLEY DR STE 100
RESTON VA
20191-3429
US

IV. Provider business mailing address

68 PINEGROVE RD
CUMBERLAND VA
23040-2110
US

V. Phone/Fax

Practice location:
  • Phone: 804-822-7594
  • Fax:
Mailing address:
  • Phone: 804-822-7594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0704008157
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: