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General NPI Number Information
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NPI Number | 1780467993
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Entity Type | Organization
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Legal Business Name | SELF KNOWLEDGE BASE AND FOUNDATION
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Dates
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Enumeration Date | 08/14/2023
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Last Update Date | 08/14/2023
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Provider Practice Location Address
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Address Line | 43803 MICHENER DR
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City | ASHBURN
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State | VA
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Zip | 20147-5807
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Country | US
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Telephone | 703-443-4924
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Fax | 703-775-1560
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Provider Business Mailing Address
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Address Line | 43803 MICHENER DR
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City | ASHBURN
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State | VA
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Zip | 20147-5807
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Country | US
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Telephone | 703-443-4924
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Fax | 703-775-1560
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Authorized Official
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Title or Position | OWNER
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Name | MICHELLE RAD
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Credential |
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Telephone | 703-443-4924
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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 |
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License Number State |
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