Healthcare Provider Details

I. General information

NPI: 1649960410
Provider Name (Legal Business Name): ROSE AKHOASEGBE EHICHIOYA PMHNP, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 GOLANSKY BLVD STE 201
WOODBRIDGE VA
22192-4268
US

IV. Provider business mailing address

1684 ROSEDALE CT
WOODBRIDGE VA
22191-3014
US

V. Phone/Fax

Practice location:
  • Phone: 703-973-0176
  • Fax: 571-428-2027
Mailing address:
  • Phone: 703-973-0176
  • Fax: 571-428-2027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024187059
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: