Individual
MR. NATHAN JOHN EDMUNDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
118 E DEL RAY AVE, ALEXANDRIA, VA 22301
(703) 348-6427
Mailing address
306 1/2 E DEL RAY AVE, ALEXANDRIA, VA 22301-1234
(626) 665-7582
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
0004017
CO
103TC0700X
Clinical Psychologist
Primary
0810005996
VA
103TC0700X
Clinical Psychologist
PSY29380
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36550264
—
CO
Enumeration date
09/18/2007
Last updated
07/20/2018
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