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General NPI Number Information
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NPI Number | 1184907537
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Entity Type | Organization
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Legal Business Name | MONICA HAYWARD
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Dates
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Enumeration Date | 09/22/2011
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Last Update Date | 09/22/2011
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Provider Practice Location Address
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Address Line | 5105Q BACKLICK RD
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City | ANNANDALE
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State | VA
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Zip | 22003-6005
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Country | US
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Telephone | 703-232-0874
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Fax | 703-590-3081
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Provider Business Mailing Address
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Address Line | 4707 KENNY CT
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City | WOODBRIDGE
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State | VA
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Zip | 22193-4805
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Country | US
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Telephone | 703-232-0874
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Fax | 703-590-3081
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Authorized Official
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Title or Position | PSYCHOTHERPIST
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Name | MRS. MONICA N HAYWARD
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Credential | L.C.S.W
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Telephone | 703-232-0874
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 0904007729
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 0904007729
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License Number State | VA
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