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DR. KIM HAVENNER PSY.D.

Clinical >> Psychologist >> Behavioral Health & Social Service Providers

Registrant NPI Number: 1972933364

Individual Registrant:
DR. KIM  HAVENNER PSY.D.
Gender: F
Sole Proprietor

Location and contact information for practice:
10805 MAIN ST STE 500  FAIRFAX, VA 22030-4747 US
Tel: 703-283-4153  Fax: --

Contact information for business:
10714 SCOTT DR  FAIRFAX, VA 22030-3023 US
Tel: 703-283-4153  Fax: --

Registration Information:
NPI: 1972933364
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y103TC0700XBehavioral Health & Social Service Providers
Psychologist
Clinical
VA0810004884

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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