Healthcare Provider Details

I. General information

NPI: 1962948174
Provider Name (Legal Business Name): EDWARD LEE CURTIS III LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: EDWARD CURTIS LPC

II. Dates (important events)

Enumeration Date: 01/11/2017
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 CAMERON GLEN DR SUITE 600
RESTON VA
20190-3363
US

IV. Provider business mailing address

1850 CAMERON GLEN DR SUITE 600
RESTON VA
20190-3363
US

V. Phone/Fax

Practice location:
  • Phone: 703-481-4159
  • Fax: 703-435-1961
Mailing address:
  • Phone: 703-481-4159
  • Fax: 703-435-1961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701006879
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: