Healthcare Provider Details

I. General information

NPI: 1598474710
Provider Name (Legal Business Name): GILLIAN KATHLEEN MACSTRAVIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2022
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 PARK TOWER DR STE 200
VIENNA VA
22180-7394
US

IV. Provider business mailing address

12992 THISTLETHORN DR
HERNDON VA
20171-2275
US

V. Phone/Fax

Practice location:
  • Phone: 703-533-3131
  • Fax:
Mailing address:
  • Phone: 703-463-8825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: