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General NPI Number Information
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NPI Number | 1699174714
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Entity Type | Organization
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Legal Business Name | NORTHSTAR PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 08/14/2014
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Last Update Date | 08/14/2014
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Provider Practice Location Address
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Address Line | 2000 N. 15TH STREET SUITE G2-100
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City | ARLINGTON
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State | VA
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Zip | 22201
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Country | US
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Telephone | 571-438-3441
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Fax | 703-812-0961
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Provider Business Mailing Address
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Address Line | 2000 N. 15TH STREET SUITE G2-100
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City | ARLINGTON
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State | VA
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Zip | 22201
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Country | US
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Telephone | 571-438-3441
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Fax | 703-812-0961
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCHOLOGIST
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Name | DR. THERESA SCHILL
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Credential | PSY.D
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Telephone | 571-438-3441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810004928
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License Number State | VA
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