Healthcare Provider Details

I. General information

NPI: 1487742615
Provider Name (Legal Business Name): LAWRENCE UMAN M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 WAINWRIGHT DR
RESTON VA
20190-3429
US

IV. Provider business mailing address

1616 WAINWRIGHT DR
RESTON VA
20190-3429
US

V. Phone/Fax

Practice location:
  • Phone: 703-868-5947
  • Fax: 703-391-7381
Mailing address:
  • Phone: 703-868-5947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT 0717000267
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC 0701002320
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: