Provider Demographics
NPI:1679286355
Name:NORTHERN VIRGINIA PSYCHIATRIC SERVICES PLLC
Entity type:Organization
Organization Name:NORTHERN VIRGINIA PSYCHIATRIC SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSHIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-554-5635
Mailing Address - Street 1:44075 PIPELINE PLZ STE 220
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5890
Mailing Address - Country:US
Mailing Address - Phone:703-283-9083
Mailing Address - Fax:
Practice Address - Street 1:44075 PIPELINE PLZ STE 220
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5890
Practice Address - Country:US
Practice Address - Phone:703-554-5635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-28
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty