Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 0810001946 | VA |
Y | 103T00000X | Psychologist | 0810001946 | VA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 0810001946 | VA |
NPI | 1023169406 |
---|---|
Provider Name | Dr. Diane Marie Hoekstra |
First Address | Fairfax, VA 22030-6913 |
Second Address | Fairfax, VA 22030-6913 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2007 |
Last Update Date | 18/08/2015 |