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General NPI Number Information
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NPI Number | 1649088527
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Entity Type | Organization
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Legal Business Name | DC PSYCHIATRY LLC
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Dates
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Enumeration Date | 12/23/2024
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Last Update Date | 12/23/2024
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Provider Practice Location Address
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Address Line | 1800 TOWN CENTER DR STE 420
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City | RESTON
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State | VA
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Zip | 20190-3240
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Country | US
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Telephone | 703-869-5361
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Fax | 703-957-3625
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Provider Business Mailing Address
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Address Line | PO BOX 710015
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City | HERNDON
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State | VA
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Zip | 20171-0015
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Country | US
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Telephone | 703-869-5361
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Fax | 703-957-3625
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Authorized Official
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Title or Position | CEO
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Name | DR. CORDELIA NIEKETIEN-TAWARI, DNP, APRN-BC, LNP
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Credential | DNP APRN-BC LNP
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Telephone | 703-869-5361
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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