Healthcare Provider Details

I. General information

NPI: 1447813506
Provider Name (Legal Business Name): NIKITA THADANI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 MAPLE AVE E STE 201B
VIENNA VA
22180-4743
US

IV. Provider business mailing address

450 MAPLE AVE E STE 201B
VIENNA VA
22180-4743
US

V. Phone/Fax

Practice location:
  • Phone: 703-594-9227
  • Fax:
Mailing address:
  • Phone: 703-594-9227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701013666
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: