Organization
NORTHERN LIGHTS PSYCHOTHERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SOFIA A GRAHAM (CLINICAL PSYCHOLOGIST/OWNER)
(571) 477-1613
Entity
Organization
Contact information
Practice address
222 CATOCTIN CIR SE STE 126, LEESBURG, VA 20175-3730
(571) 477-1613
Mailing address
24400 MOON GLADE CT, ALDIE, VA 20105-3148
(571) 379-6668
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1104228121
—
VA
Enumeration date
02/27/2020
Last updated
02/27/2020
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