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General NPI Number Information
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NPI Number | 1205109055
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Entity Type | Individual
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Provider Name | RANDALL LEAVITT PRIOR D.MIN
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Gender | Male
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Dates
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Enumeration Date | 02/09/2012
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Last Update Date | 02/09/2012
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Provider Practice Location Address
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Address Line | 10723 MAIN ST FAIRFAX PRESBYTERIAN CHURCH
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City | FAIRFAX
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State | VA
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Zip | 22030-6905
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Country | US
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Telephone | 703-270-5300
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX QQ CENTER FOR PASTORAL COUNSELING OF VIRGINIA
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City | MC LEAN
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State | VA
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Zip | 22101-0700
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Country | US
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Telephone | 703-903-9696
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State |
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