Healthcare Provider Details

I. General information

NPI: 1689881062
Provider Name (Legal Business Name): GEOFFREY MICHAELSON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2110 GALLOWS RD # A SUITE 100
VIENNA VA
22182-3962
US

IV. Provider business mailing address

1950 HOPEWOOD DR
FALLS CHURCH VA
22043-1870
US

V. Phone/Fax

Practice location:
  • Phone: 703-883-1770
  • Fax:
Mailing address:
  • Phone: 703-534-5424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0810001350
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY1574
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number0810001350
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY1574
License Number StateDC
# 5
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810001350
License Number StateVA
# 6
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY1574
License Number StateDC
# 7
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number0810001350
License Number StateVA
# 8
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY1574
License Number StateDC
# 9
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number0810001350
License Number StateVA
# 10
Primary TaxonomyY
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberPSY1574
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: