MEDICARE: DIERA PARHAM-CARRUTHERS LPC CSOTP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC013344	GA
2	101YP2500X	Professional Counselor	PRC15344	DC
3	101YP2500X	Professional Counselor	0704007656	VA
4	101YM0800X	Mental Health Counselor	LPC013344	GA
5	101YM0800X	Mental Health Counselor	PRC15344	DC
6	101YP2500X	Professional Counselor	0701010057	VA
7	101YM0800X	Mental Health Counselor	0704007656	VA

General Provider Information

NPI Number	:	1447877204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIERA PARHAM-CARRUTHERS LPC CSOTP

Provider Business Mailing Address
First Line	:	2142 RICHMOND HWY STE 103
Second Line	:
City	:	STAFFORD
State	:	VA
Zip	:	22554-7200
Country	:	US
Telephone Number	:	540-467-7497
Fax Number	:

Provider Business Practice Location Address
First Line	:	2142 RICHMOND HWY STE 103
Second Line	:
City	:	STAFFORD
State	:	VA
Zip	:	22554-7200
Country	:	US
Telephone Number	:	540-467-7497
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2020
Last Update Date	:	10/07/2025

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