Healthcare Provider Details

I. General information

NPI: 1750829883
Provider Name (Legal Business Name): IRENE TERESA PAZ PRUITT M.S., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2017
Last Update Date: 02/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 S GLEBE RD SUITE 103
ARLINGTON VA
22204-1655
US

IV. Provider business mailing address

46 S GLEBE RD SUITE 103
ARLINGTON VA
22204-1655
US

V. Phone/Fax

Practice location:
  • Phone: 703-521-6004
  • Fax: 703-521-6342
Mailing address:
  • Phone: 703-521-6004
  • Fax: 703-521-6342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701005734
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: