Healthcare Provider Details

I. General information

NPI: 1376039925
Provider Name (Legal Business Name): MICHELLE LYNN OBRIEN LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2018
Last Update Date: 07/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 K ST NW STE 300
WASHINGTON DC
20006-1631
US

IV. Provider business mailing address

73 BICKEL CT
STERLING VA
20165-5728
US

V. Phone/Fax

Practice location:
  • Phone: 703-217-1647
  • Fax:
Mailing address:
  • Phone: 703-217-1647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGPC00171
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: