=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235640087
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WARD GROUP, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2017
-----------------------------------------------------
Last Update Date | 10/19/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8440 OLD KEENE MILL RD
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22152-2302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-977-3712
-----------------------------------------------------
Fax | 703-997-4872
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4801 KENMORE AVE APT 1112
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22304-1118
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-977-3712
-----------------------------------------------------
Fax | 703-997-4872
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE MEMBER
-----------------------------------------------------
Name | LORI WARD
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 910-977-3712
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 8734
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 0701007216
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------