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General NPI Number Information
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NPI Number | 1235390550
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Entity Type | Organization
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Legal Business Name | THE COUNSELING CENTER OF NORTHERN VIRGINIA
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Dates
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Enumeration Date | 06/19/2008
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Last Update Date | 06/19/2008
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Provider Practice Location Address
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Address Line | 131 PARK ST NE
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City | VIENNA
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State | VA
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Zip | 22180-4641
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Country | US
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Telephone | 703-938-4703
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Fax | 703-938-4706
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Provider Business Mailing Address
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Address Line | 2367 HUNTER MILL RD
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City | VIENNA
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State | VA
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Zip | 22181-3005
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Country | US
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Telephone | 703-281-6326
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Fax | 703-242-0331
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Authorized Official
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Title or Position | CHAIR OF BOARD OF TRUSTEES
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Name | DR. LAWRENCE EDWARD KENNEDY JR.
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Credential | PH.D.
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Telephone | 703-281-6326
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 0717000281
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License Number State | VA
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