Provider Demographics
NPI:1861569147
Name:HAUCK, ELIZABETH ANNE (PHD CLINICAL PSYCHOL)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANNE
Last Name:HAUCK
Suffix:
Gender:F
Credentials:PHD CLINICAL PSYCHOL
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Mailing Address - Street 1:21351 GENTRY DRIVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20166-8514
Mailing Address - Country:US
Mailing Address - Phone:703-430-7740
Mailing Address - Fax:703-421-9946
Practice Address - Street 1:21351 GENTRY DRIVE
Practice Address - Street 2:SUITE 250
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-8514
Practice Address - Country:US
Practice Address - Phone:703-430-7740
Practice Address - Fax:703-421-9946
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2012-08-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0810001031103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA190001349Medicare ID - Type Unspecified