Provider Demographics
NPI:1174236343
Name:NISCO PSYCHOLOGICAL SERVICES PLLC
Entity type:Organization
Organization Name:NISCO PSYCHOLOGICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSITRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMEO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-581-8670
Mailing Address - Street 1:21351 GENTRY DR STE 250
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20166-8514
Mailing Address - Country:US
Mailing Address - Phone:703-727-9729
Mailing Address - Fax:703-421-9946
Practice Address - Street 1:21351 GENTRY DR STE 250
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-8514
Practice Address - Country:US
Practice Address - Phone:037-279-7297
Practice Address - Fax:703-421-9946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty