Healthcare Provider Details

I. General information

NPI: 1275627861
Provider Name (Legal Business Name): MARGUERITE COPE HURSH LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5675 STONE RD SUITE 300
CENTREVILLE VA
20120-1667
US

IV. Provider business mailing address

15141 OLDDALE ROAD
CENTREVILLE VA
20120-1409
US

V. Phone/Fax

Practice location:
  • Phone: 703-715-6077
  • Fax: 703-631-6982
Mailing address:
  • Phone: 703-631-6982
  • Fax: 703-631-6982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701002921
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: