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NORTHERN LIGHTS PSYCHOTHERAPY NPI 1104450105


NPI Information

NPI: 1104450105
Provider Name: NORTHERN LIGHTS PSYCHOTHERAPY
Classification: Psychologist - 103TC0700X
Entity Type: Organization

Specialization: Clinical

Address:
222 CATOCTIN CIR SE STE 126
LEESBURG, VA
ZIP 20175
Phone: (571) 477-1613
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NORTHERN LIGHTS PSYCHOTHERAPY is a clinical psychologist in Leesburg, VA. The provider is a psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems. NORTHERN LIGHTS PSYCHOTHERAPY NPI is 1104450105. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

222 CATOCTIN CIR SE STE 126
LEESBURG, VA
ZIP 20175-730
Phone: (571) 477-1613

The provider's authorized official is Sofia A Graham .
The authorized official title is Clinical Psychologist/owner and has the following contact phone number (571) 477-1613.

The enumeration date for this NPI number is 2/27/2020 and was last updated on 2/27/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1103TC0700XPsychologistClinicalYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11104228121MEDICAIDVIRGINIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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