Provider Demographics
NPI:1821771106
Name:GOLDBACH, CHLOE MICHELLE (PHD)
Entity type:Individual
Prefix:
First Name:CHLOE
Middle Name:MICHELLE
Last Name:GOLDBACH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 SULGRAVE CT
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-6410
Mailing Address - Country:US
Mailing Address - Phone:904-343-0388
Mailing Address - Fax:
Practice Address - Street 1:4620 CHERRY HILL RD STE 213
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22207-3418
Practice Address - Country:US
Practice Address - Phone:904-343-0388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-11
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07439103T00000X
VA0810008459103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist