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General NPI Number Information
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NPI Number | 1154056836
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Entity Type | Individual
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Provider Name | MICHAEL VIRES LGPC
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Gender | Male
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Dates
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Enumeration Date | 07/18/2022
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Last Update Date | 07/18/2022
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Provider Practice Location Address
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Address Line | 2205 WARWICK WAY STE 100
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City | MARRIOTTSVILLE
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State | MD
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Zip | 21104-1631
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Country | US
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Telephone | 240-883-6847
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Fax |
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Provider Business Mailing Address
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Address Line | 17711 GLOBE THEATRE DR
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City | OLNEY
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State | MD
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Zip | 20832-1676
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Country | US
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Telephone | 301-706-4375
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LGP12753
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License Number State | MD
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