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General NPI Number Information
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NPI Number | 1508149907
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Entity Type | Organization
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Legal Business Name | A.C.E PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 09/21/2011
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Last Update Date | 09/21/2011
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Provider Practice Location Address
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Address Line | 11198 LEE HWY STE D2
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City | FAIRFAX
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State | VA
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Zip | 22030-5009
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Country | US
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Telephone | 703-330-3105
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Fax | 703-621-1128
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Provider Business Mailing Address
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Address Line | 11198 LEE HWY STE D2
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City | FAIRFAX
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State | VA
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Zip | 22030-5009
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Country | US
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Telephone | 703-330-3105
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Fax | 703-621-1128
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCHOLOGIST
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Name | DR. LAUREN FISHER
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Credential | PSYD
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Telephone | 703-330-3105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 0810003919
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License Number State | VA
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