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General NPI Number Information
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NPI Number | 1073522124
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Entity Type | Organization
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Legal Business Name | ASSOCIATED CLINICAL SERVICES
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Dates
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Enumeration Date | 08/07/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8348 TRAFORD LN SUITE 102
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City | SPRINGFIELD
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State | VA
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Zip | 22152
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Country | US
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Telephone | 703-569-8731
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Fax | 703-569-7248
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Provider Business Mailing Address
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Address Line | 8348 TRAFORD LN SUITE 102
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City | SPRINGFIELD
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State | VA
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Zip | 22152-1663
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Country | US
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Telephone | 703-569-8731
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Fax | 703-569-7248
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Authorized Official
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Title or Position | PRESIDENT/CLINICAL PSYCHOLOGIST
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Name | DR. EDWIN N. CARTER
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Credential | PH.D.
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Telephone | 703-569-8731
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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