Organization
INTEGRATED CLINICAL CONCEPTS
Active
Other names
Associated Clinical Services of Herndon
Organization subpart
No
Provider details
NPI number
Authorized official
JUDITH L WALD PSYD (OWNER)
(703) 481-6001
Entity
Organization
Contact information
Practice address
481 CARLISLE DRIVE, SUITE 112, HERNDON, VA 20170
(703) 481-6001
(703) 481-5664
Mailing address
481 CARLISLE DRIVE, SUITE 112, HERNDON, VA 20170
(703) 481-6001
(703) 481-5664
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
VA
101YP2500X
Professional Counselor
—
—
103TC0700X
Clinical Psychologist
—
VA
103TC0700X
Clinical Psychologist
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
Other
Enumeration date
03/12/2008
Last updated
10/30/2009
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