Northern Lights Psychotherapy

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

NORTHERN LIGHTS PSYCHOTHERAPY

Practice address

222 Catoctin Cir SE Ste 126
Leesburg, VA 20175-3730

Phone

(571) 477-1613

NPI assigned

Feb 27, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sofia A GrahamNPI 1104228121

Title

Clinical Psychologist/Owner

Phone

(571) 477-1613

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Sofia Graham, PSY.D.

  • Clinical Psychologist
  • Leesburg, VA
  • NPI 1104228121
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1582761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582761600000",
    "number": "1104450105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24400 MOON GLADE CT",
            "city": "ALDIE",
            "state": "VA",
            "postal_code": "201053148",
            "telephone_number": "571-379-6668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 CATOCTIN CIR SE STE 126",
            "city": "LEESBURG",
            "state": "VA",
            "postal_code": "201753730",
            "telephone_number": "571-477-1613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN LIGHTS PSYCHOTHERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-27",
        "last_updated": "2020-02-27",
        "certification_date": "2020-02-27",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "SOFIA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST/OWNER",
        "authorized_official_telephone_number": "571-477-1613"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1104228121",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Leesburg, VA
• Providers in Leesburg, VA by specialty
• Clinical Psychologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.