Active NPI
Jordan Wilson, PSYD
- Clinical Psychologist
- Manassas, VA
National Provider Identifier
1578073821
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 0810005701
- Practice address
- 8140 Ashton Ave
Suite 200
Manassas, VA 20109 - Phone
- (703) 330-9933
- NPI assigned
- Oct 1, 2017
- Last updated
- Oct 1, 2017
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 0810005701 | VA | Primary |
Addresses
Primary practice location
8140 Ashton Ave
Suite 200
Manassas, VA 20109
Mailing address
301 W Broad St
Falls Church, VA 22046-3335
Phone (757) 784-2454
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0810005701 | VA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1506816000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1506816000000",
"number": "1578073821",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "301 W BROAD ST",
"city": "FALLS CHURCH",
"state": "VA",
"postal_code": "220463335",
"telephone_number": "757-784-2454"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8140 ASHTON AVE",
"address_2": "SUITE 200",
"city": "MANASSAS",
"state": "VA",
"postal_code": "20109",
"telephone_number": "703-330-9933"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "JORDAN",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-10-01",
"last_updated": "2017-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "VA",
"license": "0810005701",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Manassas, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.