Healthcare Provider Details

I. General information

NPI: 1932425774
Provider Name (Legal Business Name): MS. SANDRA CHERYL MALAWER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SANDRA CHERYL MALAWER LPC, LMFT

II. Dates (important events)

Enumeration Date: 04/19/2010
Last Update Date: 04/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 VINCENT PL
MC LEAN VA
22101-3615
US

IV. Provider business mailing address

1313 VINCENT PL
MC LEAN VA
22101-3615
US

V. Phone/Fax

Practice location:
  • Phone: 703-893-9063
  • Fax:
Mailing address:
  • Phone: 703-893-9063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701001229
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: