Healthcare Provider Details

I. General information

NPI: 1083134308
Provider Name (Legal Business Name): KAREN MAKAR JEANNETTE LPC, LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8508 WESTOVER CT
SPRINGFIELD VA
22152-1052
US

IV. Provider business mailing address

79 HAYWOOD ST
SPRING LAKE NC
28390-9194
US

V. Phone/Fax

Practice location:
  • Phone: 571-376-3452
  • Fax:
Mailing address:
  • Phone: 571-376-3452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0701007019
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number19917
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401223545
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701007019
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number19917
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701007019
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: