Active NPI
Nicole Beadles, PHD
- Psychologist
- Fairfax, VA
National Provider Identifier
1194189944
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 0810003878
- Practice address
- 3925 Blenheim Blvd Ste 52a
Fairfax, VA 22030-2426 - Phone
- (571) 354-0844
- NPI assigned
- Apr 7, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 0810003878 | VA | Primary |
Addresses
Primary practice location
3925 Blenheim Blvd Ste 52a
Fairfax, VA 22030-2426
Mailing address
1517 Inlet CT
Reston, VA 20190-4422
Phone (571) 354-0844
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0810003878 | VA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1459987200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1689638400000",
"number": "1194189944",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1517 INLET CT",
"city": "RESTON",
"state": "VA",
"postal_code": "201904422",
"telephone_number": "571-354-0844"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3925 BLENHEIM BLVD STE 52A",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "220302426",
"telephone_number": "571-354-0844"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BEADLES",
"first_name": "NICOLE",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-04-07",
"last_updated": "2023-07-18",
"certification_date": "2023-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "VA",
"license": "0810003878",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairfax, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.