Provider Demographics
NPI:1447322888
Name:O'MALLEY, ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:
Last Name:O'MALLEY
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 1:11198 LEE HWY
Mailing Address - Street 2:SUITE D2
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-5008
Mailing Address - Country:US
Mailing Address - Phone:703-350-2928
Mailing Address - Fax:
Practice Address - Street 1:11198 LEE HWY
Practice Address - Street 2:SUITE D2
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-5008
Practice Address - Country:US
Practice Address - Phone:703-350-2928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003742103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical