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General NPI Number Information
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NPI Number | 1790988715
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Entity Type | Organization
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Legal Business Name | CHILD & FAMILY HEALING HOUSE
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 14688 NINA CT
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City | WATERFORD
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State | VA
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Zip | 20197-1635
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Country | US
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Telephone | 703-999-4844
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Fax |
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Provider Business Mailing Address
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Address Line | 14688 NINA CT
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City | WATERFORD
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State | VA
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Zip | 20197-1635
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Country | US
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Telephone | 703-999-4844
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HOLIDAY RONDEAU
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Credential | PSY.D.
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Telephone | 703-999-4844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 0810002152
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License Number State | VA
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