Individual
FERNANDO MANUEL AVILA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D
Contact information
Practice address
2671 AVENIR PL, VIENNA, VA 22180-7485
(703) 207-8600
Mailing address
11125 PELHAM LN, FAIRFAX, VA 22030-4518
(626) 203-3242
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
0810005615
VA
103TC0700X
Clinical Psychologist
Primary
PSY31410
CA
103TC0700X
Clinical Psychologist
RPS 2012468
CA
Other
Enumeration date
08/29/2011
Last updated
01/28/2020
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