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General NPI Number Information
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NPI Number | 1215276365
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Entity Type | Individual
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Provider Name | LORI BRISTOW PH.D.
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Gender | Female
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Dates
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Enumeration Date | 02/10/2013
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Last Update Date | 08/26/2016
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Provider Practice Location Address
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Address Line | 6723 WHITTIER AVE SUITE 206
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City | MC LEAN
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State | VA
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Zip | 22101-4522
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Country | US
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Telephone | 703-477-0692
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Fax |
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Provider Business Mailing Address
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Address Line | 7600 LAKESIDE VILLAGE DR UNIT D
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City | FALLS CHURCH
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State | VA
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Zip | 22042-7548
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 0810004605
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License Number State | VA
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