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General NPI Number Information
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NPI Number | 1891245080
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Entity Type | Organization
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Legal Business Name | CS PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 10/11/2016
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Last Update Date | 10/11/2016
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Provider Practice Location Address
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Address Line | 7001 HERITAGE VILLAGE PLZ STE 230
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City | GAINESVILLE
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State | VA
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Zip | 20155-3095
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Country | US
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Telephone | 571-389-4639
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Fax |
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Provider Business Mailing Address
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Address Line | 7001 HERITAGE VILLAGE PLZ STE 230
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City | GAINESVILLE
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State | VA
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Zip | 20155-3095
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Country | US
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Telephone | 571-389-4639
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Fax |
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Authorized Official
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Title or Position | OWNER/LICENSED CLINICAL PSYCHOLOGIS
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Name | CARI SHORT
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Credential | PSY.D.
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Telephone | 571-389-4639
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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 | 0810005234
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License Number State | VA
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