Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 0810003763 | VA |
Y | 103TC0700X | Clinical Psychologist | 0810003763 | VA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY19714 | CA |
NPI | 1013906478 |
---|---|
Provider Name | Courtney Thomas |
First Address | Reston, VA 20190-3442 |
Second Address | Herndon, VA 20170-5100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2005 |
Last Update Date | 19/03/2014 |