Individual
TARA WALL BROWN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
8500 EXECUTIVE PARK AVE, SUITE 200, FAIRFAX, VA 22031-2225
(703) 698-5200
(703) 573-2351
Mailing address
8500 EXECUTIVE PARK AVE, SUITE 200, FAIRFAX, VA 22031-2225
(703) 698-5200
(703) 573-2351
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
0810003400
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0081
CAREFIRST DC
VA
01
—
139478
ANTHEM
VA
01
—
2160264
MAMSI
—
01
—
681761
NCPPO
VA
01
—
735839-000
MAGELLAN
VA
01
—
7513603
AETNA
—
Enumeration date
07/15/2005
Last updated
11/10/2011
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