Healthcare Provider Details

I. General information

NPI: 1477762649
Provider Name (Legal Business Name): NEIL P MCNERNEY LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1984 ISAAC NEWTON SQ W SUITE 204
RESTON VA
20190-5038
US

IV. Provider business mailing address

38878 MOUNT GILEAD RD
LEESBURG VA
20175-6719
US

V. Phone/Fax

Practice location:
  • Phone: 703-352-9002
  • Fax: 703-464-8669
Mailing address:
  • Phone: 703-352-7003
  • Fax: 703-464-8669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701002288
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: