Healthcare Provider Details

I. General information

NPI: 1265396022
Provider Name (Legal Business Name): ALEXANDRA LEIGH HALLER MS, ATR-P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 CHURCH ST NW STE 205
VIENNA VA
22180-4550
US

IV. Provider business mailing address

7600 WOOD MILL CT
RICHMOND VA
23231-7157
US

V. Phone/Fax

Practice location:
  • Phone: 571-234-8050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number25-753
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: