Organization
PRIVIA MEDICAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
COURTNEY AINSWORTH IVESS (ASSOCIATE DIRECTOR)
(571) 366-8831
Entity
Organization
Contact information
Practice address
1201 SEVEN LOCKS RD STE 111, ROCKVILLE, MD 20854-2957
(571) 366-8850
Mailing address
950 N GLEBE RD STE 700, ARLINGTON, VA 22203-4173
(571) 366-8831
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
103TC0700X
Clinical Psychologist
—
—
103TC1900X
Counseling Psychologist
—
—
Other
Enumeration date
01/04/2021
Last updated
01/04/2021
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