Healthcare Provider Details

I. General information

NPI: 1386550390
Provider Name (Legal Business Name): REEYA GANDHI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8230 OLD COURTHOUSE RD STE 500
VIENNA VA
22182-3840
US

IV. Provider business mailing address

12105 PINE FOREST CIR APT D
FAIRFAX VA
22030-7709
US

V. Phone/Fax

Practice location:
  • Phone: 703-281-4928
  • Fax:
Mailing address:
  • Phone: 870-423-8649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0906017862
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: