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General NPI Number Information
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NPI Number | 1366173668
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Entity Type | Individual
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Provider Name | AILISH A RIGGS DERMODY
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Gender | Female
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Dates
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Enumeration Date | 06/19/2022
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Last Update Date | 06/19/2022
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Provider Practice Location Address
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Address Line | 520 N WASHINGTON ST STE 100
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City | FALLS CHURCH
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State | VA
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Zip | 22046-3538
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Country | US
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Telephone | 202-813-0696
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Fax |
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Provider Business Mailing Address
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Address Line | 11145 GLADE DR
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City | RESTON
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State | VA
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Zip | 20191-4706
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Country | US
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Telephone | 415-990-0973
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0704014865
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License Number State | VA
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