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General NPI Number Information
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NPI Number | 1902237837
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Entity Type | Individual
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Provider Name | SONYA D MELLERSON PHD, NCSP
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Gender | Female
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Dates
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Enumeration Date | 12/03/2013
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Last Update Date | 10/08/2025
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Provider Practice Location Address
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Address Line | 8115 GATEHOUSE RD
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City | FALLS CHURCH
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State | VA
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Zip | 22042-1203
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Country | US
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Telephone | 571-423-4102
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Fax |
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Provider Business Mailing Address
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Address Line | 11410 RESTON STATION BLVD APT 204
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City | RESTON
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State | VA
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Zip | 20190-5387
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Country | US
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Telephone | 803-983-8236
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 70697
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | PPS-0604541
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License Number State | VA
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