Organization
ALEXANDRIA CSB
Active
Organization
ALEXANDRIA CSB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MERCEDES WILSON DALLAS PH.D. (CLINICAL PSYCHOLOGIST)
(703) 838-6400
Entity
Organization
Contact information
Practice address
720 N SAINT ASAPH ST, FOURTH FLOOR, ALEXANDRIA, VA 22314-1912
(703) 838-6400
(703) 838-5070
Mailing address
4906 SHARON RD, CAMP SPRINGS, MD 20748-2236
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
0810001425
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0025
CARE FIRST BCBS
VA
01
—
008746A25
MEDICARE
VA
01
—
188512
ANTHEM
VA
01
—
270291
AMERIGROUP
VA
Enumeration date
12/13/2006
Last updated
08/22/2020
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