1215035183 NPI number — DR. CHRISTOPHER HALEY PSYD

Table of content: DR. CHRISTOPHER HALEY PSYD (NPI 1215035183)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215035183 NPI number — DR. CHRISTOPHER HALEY PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALEY
Provider First Name:
CHRISTOPHER
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215035183
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13885 HEDGEWOOD DRIVE
Provider Second Line Business Mailing Address:
SUITE 245
Provider Business Mailing Address City Name:
WOODRIDGE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22193
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-490-0336
Provider Business Mailing Address Fax Number:
703-490-4525

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13885 HEDGEWOOD DRIVE
Provider Second Line Business Practice Location Address:
SUITE 245
Provider Business Practice Location Address City Name:
WOODRIDGE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22193
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-490-0336
Provider Business Practice Location Address Fax Number:
703-490-4525
Provider Enumeration Date:
09/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  0810002757 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: 0810002757 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 030389866 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 218354 . This is a "KAISER PERMANENTE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 23570010 . This is a "CAREFIRST" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 275693 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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