Healthcare Provider Details

I. General information

NPI: 1942790951
Provider Name (Legal Business Name): NICHOLAS EDWARD SEARLE MS, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2018
Last Update Date: 05/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43130 AMBERWOOD PLZ STE 140
CHANTILLY VA
20152
US

IV. Provider business mailing address

25664 LAUGHTER DR
ALDIE VA
20105-2580
US

V. Phone/Fax

Practice location:
  • Phone: 703-348-0030
  • Fax: 703-542-7770
Mailing address:
  • Phone: 703-989-3615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701007630
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: