Healthcare Provider Details

I. General information

NPI: 1073522124
Provider Name (Legal Business Name): ASSOCIATED CLINICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8348 TRAFORD LN SUITE 102
SPRINGFIELD VA
22152
US

IV. Provider business mailing address

8348 TRAFORD LN SUITE 102
SPRINGFIELD VA
22152-1663
US

V. Phone/Fax

Practice location:
  • Phone: 703-569-8731
  • Fax: 703-569-7248
Mailing address:
  • Phone: 703-569-8731
  • Fax: 703-569-7248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. EDWIN N. CARTER
Title or Position: PRESIDENT/CLINICAL PSYCHOLOGIST
Credential: PH.D.
Phone: 703-569-8731