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General NPI Number Information
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NPI Number | 1245756782
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Entity Type | Individual
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Provider Name | JOHN CONOVER VYMETAL-TAYLOR LPC
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Gender | Male
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Dates
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Enumeration Date | 08/16/2017
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Last Update Date | 06/18/2024
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Provider Practice Location Address
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Address Line | 4850 MARK CENTER DR
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City | ALEXANDRIA
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State | VA
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Zip | 22311-1882
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Country | US
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Telephone | 703-746-6004
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Fax |
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Provider Business Mailing Address
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Address Line | 2708 S JUNE ST
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City | ARLINGTON
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State | VA
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Zip | 22202-2253
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Country | US
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Telephone | 571-379-9154
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701007064
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0711000325
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License Number State | VA
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