Healthcare Provider Details

I. General information

NPI: 1447877204
Provider Name (Legal Business Name): DIERA PARHAM-CARRUTHERS LPC CSOTP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2020
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2142 RICHMOND HWY STE 103
STAFFORD VA
22554-7200
US

IV. Provider business mailing address

2142 RICHMOND HWY STE 103
STAFFORD VA
22554-7200
US

V. Phone/Fax

Practice location:
  • Phone: 540-467-7497
  • Fax:
Mailing address:
  • Phone: 540-467-7497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC013344
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPRC15344
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0704007656
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC013344
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPRC15344
License Number StateDC
# 6
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0704007656
License Number StateVA
# 7
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701010057
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: