Provider Demographics
NPI:1366173668
Name:RIGGS DERMODY, AILISH A
Entity type:Individual
Prefix:
First Name:AILISH
Middle Name:A
Last Name:RIGGS DERMODY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11145 GLADE DR
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-4706
Mailing Address - Country:US
Mailing Address - Phone:415-990-0973
Mailing Address - Fax:
Practice Address - Street 1:520 N WASHINGTON ST STE 100
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3538
Practice Address - Country:US
Practice Address - Phone:202-813-0696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-19
Last Update Date:2022-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704014865101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health