Healthcare Provider Details

I. General information

NPI: 1376890228
Provider Name (Legal Business Name): HEATHER ABBOTT PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2012
Last Update Date: 08/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8134 OLD KEENE MILL RD STE 101
SPRINGFIELD VA
22152-1849
US

IV. Provider business mailing address

9255 OLD BEECH CT
LORTON VA
22079-4700
US

V. Phone/Fax

Practice location:
  • Phone: 703-569-8731
  • Fax:
Mailing address:
  • Phone: 703-635-0721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0810004604
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: