Northern Lights Psychotherapy
NPI 1104450105ActiveOrganization· Psychologist, Clinical· Leesburg, VA
Psychologist, Clinical in Leesburg, Virginia, registered in NPPES in February 2020. The authorized official on file is Sofia A. Graham, Clinical Psychologist/Owner. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1104450105 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Feb 27, 2020 |
| Last updated in NPPES | Feb 27, 2020 |
| Certified by provider | Feb 27, 2020 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Psychologist, Clinical Primary | 103TC0700X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (VA) |
|---|
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