Healthcare Provider Details

I. General information

NPI: 1164206942
Provider Name (Legal Business Name): KUAN-I WU MS, MSED
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 08/22/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17606 DUMFRIES RD, SUITE 204
DUMFRIES VA
22026
US

IV. Provider business mailing address

PO BOX 151
DUMFRIES VA
22026-0151
US

V. Phone/Fax

Practice location:
  • Phone: 703-221-1263
  • Fax:
Mailing address:
  • Phone: 703-221-1263
  • Fax: 866-311-4280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGPC200001576
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0704016137
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: