Most Relevant Information
Provider Data
| NPI Number: | 1003649740 |
| Provider Name: | PHILIP PHAM |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: | BACB95490 |
Most Important Dates
| Enumeration Date: | 08/20/2024 |
| Last Updated: | 08/20/2024 |
Provider Practice Location
7600 LEESBURG PIKE STE 204
FALLS CHURCH
VA
220432004
Practice Location Phone/Fax
| Phone: | 5712820092 |
| Fax: |
Provider Mailing Location
6765 STONE MAPLE TER
CENTREVILLE
VA
201215737
Provider Mailing Phone/Fax
| Phone: | 7032091046 |
| Fax: |