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General NPI Number Information
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NPI Number | 1083126882
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Entity Type | Organization
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Legal Business Name | SUMMIT COUNSELING LLC
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Dates
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Enumeration Date | 11/02/2017
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Last Update Date | 11/02/2017
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Provider Practice Location Address
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Address Line | 3801 FAIRFAX DR STE 61
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City | ARLINGTON
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State | VA
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Zip | 22203-1762
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Country | US
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Telephone | 703-740-9840
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Fax |
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Provider Business Mailing Address
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Address Line | 4146 6TH ST S
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City | ARLINGTON
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State | VA
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Zip | 22204-1408
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Country | US
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Telephone | 571-289-7631
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. MATTHEW LEVINE
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Credential | LCSW
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Telephone | 703-740-9840
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LC50080779
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904009452
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License Number State | VA
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