Basic Information
| Provider Information | |||||||||
| NPI: | 1760816433 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCDONNELL | ||||||||
| FirstName: | CASSANDRA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11835 HAZEL CIRCLE DR | ||||||||
| Address2: | |||||||||
| City: | BRISTOW | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201362180 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7036365100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 42009 VICTORY LN | ||||||||
| Address2: | |||||||||
| City: | LEESBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201766269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307584515 | ||||||||
| FaxNumber: | 3307582862 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2013 | ||||||||
| LastUpdateDate: | 02/11/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 0810004792 | VA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.