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General NPI Number Information
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NPI Number | 1972039634
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Entity Type | Individual
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Provider Name | ELEONORA SADIKOVA
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Gender | Female
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Dates
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Enumeration Date | 05/02/2017
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 9707 KEY WEST AVE STE 100
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City | ROCKVILLE
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State | MD
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Zip | 20850-3992
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Country | US
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Telephone | 240-750-6467
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Fax |
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Provider Business Mailing Address
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Address Line | 4132 E JACK JOUETT RD
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City | LOUISA
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State | VA
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Zip | 23093-3140
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Country | US
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Telephone | 703-405-9723
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810008678
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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