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General NPI Number Information
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NPI Number | 1275066078
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Entity Type | Organization
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Legal Business Name | IRIS THERAPY SERVICES, LLC
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Dates
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Enumeration Date | 04/07/2017
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Last Update Date | 03/28/2023
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Provider Practice Location Address
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Address Line | 2000 15TH ST N STE 1003
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City | ARLINGTON
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State | VA
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Zip | 22201-2683
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Country | US
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Telephone | 703-520-1072
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 15TH ST N STE 1003
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City | ARLINGTON
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State | VA
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Zip | 22201-2683
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Country | US
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Telephone | 703-520-1072
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DHURATA MAJKO
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Credential |
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Telephone | 703-505-2191
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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 | 0810005652
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License Number State | VA
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