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General NPI Number Information
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NPI Number | 1619066727
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGICAL AND LIFE SKILLS ASSOCIATES, P.C.
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 09/19/2016
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Provider Practice Location Address
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Address Line | 13885 HEDGEWOOD DR STE 245 PSYCHOLOGICAL AND LIFE SKILLS ASSOCIATES, P.C.
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City | WOODBRIDGE
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State | VA
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Zip | 22193-7931
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Country | US
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Telephone | 703-490-0336
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Fax | 703-490-4525
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Provider Business Mailing Address
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Address Line | 13885 HEDGEWOOD DR STE 245 PSYCHOLOGICAL AND LIFE SKILLS ASSOCIATES, P.C.
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City | WOODBRIDGE
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State | VA
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Zip | 22193-7931
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Country | US
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Telephone | 703-490-0336
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Fax | 703-490-4525
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHRISTOPHER T HALEY
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Credential | PSY D
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Telephone | 703-490-0336
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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 |
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License Number State |
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