Healthcare Provider Details

I. General information

NPI: 1376824466
Provider Name (Legal Business Name): NILES COOK PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2011
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8245 BOONE BLVD STE 630
VIENNA VA
22182-3894
US

IV. Provider business mailing address

8245 BOONE BLVD STE 630
VIENNA VA
22182-3894
US

V. Phone/Fax

Practice location:
  • Phone: 703-261-9148
  • Fax:
Mailing address:
  • Phone: 703-261-9148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0810008468
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: