MEDICARE: SAMAR LIDA TEHRANI CSAC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	0710102789	VA

General Provider Information

NPI Number	:	1871939413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMAR LIDA TEHRANI CSAC

Provider Business Mailing Address
First Line	:	2300 N PERSHING DR
Second Line	:	SUITE 201 #10
City	:	ARLINGTON
State	:	VA
Zip	:	22201-1428
Country	:	US
Telephone Number	:	202-681-1281
Fax Number	:	202-681-1281

Provider Business Practice Location Address
First Line	:	2300 N PERSHING DR
Second Line	:	SUITE 201 #10
City	:	ARLINGTON
State	:	VA
Zip	:	22201-1428
Country	:	US
Telephone Number	:	202-681-1281
Fax Number	:	202-681-1281

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

Provider Enumeration Date	:	05/21/2013
Last Update Date	:	05/21/2013

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