Healthcare Provider Details

I. General information

NPI: 1902559149
Provider Name (Legal Business Name): SALMA ABUGIDEIRI LPC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2022
Last Update Date: 01/28/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 BEVERLY RD STE 303
MC LEAN VA
22101-3644
US

IV. Provider business mailing address

43656 PIERPOINT TER
LEESBURG VA
20176-8405
US

V. Phone/Fax

Practice location:
  • Phone: 703-435-8667
  • Fax: 571-758-4182
Mailing address:
  • Phone: 703-340-4510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: SALMA E ABUGIDEIRI
Title or Position: OWNER
Credential: LPC
Phone: 703-435-8667