MARTHA M GILLIS (NPI# 1871657080) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871657080 |
| Entity Type | Individual |
| Full Name | MARTHA M GILLIS |
| Credential | PH.D. |
| Practice Address |
11166 Fairfax Blvd Suite 203 Fairfax VA 22030-5017 |
| Practice Telephone | 7038198445 |
| Mailing Telephone | 7038198445 |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2011-11-29 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
0810003445 | VA | Behavioral Health & Social Service Providers |
| Street Address |
11166 FAIRFAX BLVD SUITE 203 |
| City | FAIRFAX |
| State | VA |
| Zip Code | 22030-5017 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669423372 | State of The Art Rehab, Inc. | Physical Medicine & Rehabilitation | 11166 Fairfax Blvd, Suite 202, Fairfax, VA 22030-5017 | 2006-05-15 |
| 1760956163 | Sarah Abdel-wahab | Psychologist | 11166 Fairfax Blvd, Fairfax, VA 22030-5017 | 2019-01-18 |
| 1326432964 | Hyosun Schluge | Nurse Practitioner | 11166 Fairfax Blvd, #105, Fairfax, VA 22030-5017 | 2015-03-20 |
| 1609201037 | Justine Simpson | Psychologist | 11166 Fairfax Blvd, Suite 207, Fairfax, VA 22030-5017 | 2013-09-04 |
| 1669714903 | Bridges Therapy and Wellness Center, LLC | Psychologist | 11166 Fairfax Blvd, Suite 207, Fairfax, VA 22030-5017 | 2013-03-25 |
| 1306109590 | Better Life Pain Clinic, Pllc | Physical Medicine & Rehabilitation | 11166 Fairfax Blvd, Suite 105, Fairfax, VA 22030-5017 | 2012-06-21 |
| 1336375450 | Su Min Ko | Physical Medicine & Rehabilitation | 11166 Fairfax Blvd, Suite 105, Fairfax, VA 22030-5017 | 2009-06-03 |
| 1598985434 | Jung Gook Lim | Psychiatry & Neurology | 11166 Fairfax Blvd, Suite 105, Fairfax, VA 22030-5025 | 2007-04-25 |
| 1730277963 | Kalpana Shriprakash Trivedi | Dentist | 11166 Fairfax Blvd, #400, Fairfax, VA 22030-5017 | 2006-10-11 |
| 1831108125 | Anita Zappone | Clinical Nurse Specialist | 11166 Fairfax Blvd, 405, Fairfax, VA 22030-5017 | 2006-08-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205449477 | Perry Camp Jr. | Psychologist | 4403 Dixie Hill Rd, Unit 205, Fairfax, VA 22030 | 2020-08-28 |
| 1952940322 | Brightview Fair Oaks, LLC | Alzheimer Center (Dementia Center) | 12725 Lee Highway, Fairfax, VA 22030 | 2020-01-02 |
| 1245871524 | Tori Sprowl | Behavioral Analyst | 10430 Democracy Lane #102b & 103, Fairfax, VA 22030 | 2019-10-08 |
| 1528612124 | Paul Sarigianis | Student in an Organized Health Care Education/Training Program | 10379b Democracy Lane, Fairfax, VA 22030 | 2019-07-31 |
| 1497221303 | Kahak, Inc. | Day Training, Developmentally Disabled Services | 10560 Main Street Suite Ps100, Fairfax, VA 22030 | 2018-10-17 |
| 1689177073 | Shamoona Sharif | Dentist | 11050 Lee Hwy, Fairfax, VA 22030 | 2018-03-13 |
| 1205339538 | Rachael Lee Greene | Social Worker | 4403 Dixie Hill Rd. #206, Fairfax, VA 22030 | 2018-03-13 |
| 1558863027 | Jacqueline Renee Bauer | Skilled Nursing Facility | 10701 Main Street, Fairfax, VA 22030 | 2018-03-01 |
| 1275033607 | Philajo Global LLC | Non-emergency Medical Transport (VAN) | 4521 Billingham Street, Fairfax, VA 22030 | 2018-02-12 |
| 1376050401 | Alexander Harrison | Counselor | 4400 University Drive, Ms 2a2, Fairfax, VA 22030 | 2018-01-10 |
| Find all providers in zip 22030 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699232173 | Alexis Melville | Psychologist | 4094 Majestic Ln Unit 315, Fairfax, VA 22033-2104 | 2019-02-21 |
| 1558867333 | Kyoung Deok Baik | Psychologist | 3554 Chain Bridge Rd Ste 103, Fairfax, VA 22030-2709 | 2018-04-02 |
| 1265849822 | Shushan Campbell | Psychologist | 10521 Rosehaven St Ste 100, Fairfax, VA 22030-2877 | 2014-07-16 |
| 1679994867 | Claire Bartick | Psychologist | 9707 Commonwealth Blvd, Fairfax, VA 22032-2824 | 2013-12-15 |
| 1972933364 | Kim Havenner | Psychologist | 10805 Main St Ste 500, Fairfax, VA 22030-4747 | 2013-11-21 |
| 1912348343 | Tanisha S Bracey | Psychologist | 5403 Cabot Ridge Ct, Fairfax, VA 22032-3214 | 2013-07-15 |
| 1477833168 | Leslie Ann Hawkins | Psychologist | 9840 Main St Ste 201, Fairfax, VA 22031-3909 | 2011-08-25 |
| 1982998910 | Barbara G Smith | Psychologist | 11216 Waples Mill Road, Suite 104, Fairfax, VA 22030 | 2011-06-07 |
| 1184918401 | Martina Pavlicek | Psychologist | 11130 Fairfax Blvd Ste 305, Fairfax, VA 22030-5035 | 2011-06-03 |
| 1821303264 | Lianna R Bennett | Psychologist | 3607 Chain Bridge Rd, Ste A, Fairfax, VA 22030-3242 | 2010-08-10 |
| Find all providers in FAIRFAX | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.