Organization
EVOLUTION PSYCHOLOGICAL SERVICES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REGINALD HENRY MCRAE PSYD (CHIEF EXECUTIVE OFFICER)
(703) 317-7271
Entity
Organization
Contact information
Practice address
13885 HEDGEWOOD DR, SUITE 349, WOODBRIDGE, VA 22193-7928
(703) 317-7271
Mailing address
2465 DONNINGTON CT, JEFFERSONTON, VA 22724-1730
(540) 937-7676
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810004799
VA
Other
Enumeration date
01/14/2017
Last updated
01/14/2017
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