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General NPI Number Information
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NPI Number | 1255724936
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Entity Type | Organization
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Legal Business Name | PHYLLIS MILLER PALOMBI MS, LMFT
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Dates
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Enumeration Date | 03/05/2015
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Last Update Date | 03/05/2015
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Provider Practice Location Address
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Address Line | 11524 HEMINGWAY DR
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City | RESTON
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State | VA
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Zip | 20194-1252
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Country | US
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Telephone | 703-435-7686
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Fax | 703-563-9181
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Provider Business Mailing Address
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Address Line | 11524 HEMINGWAY DR
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City | RESTON
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State | VA
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Zip | 20194-1252
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Country | US
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Telephone | 703-435-7686
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Fax | 703-563-9181
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Authorized Official
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Title or Position | FAMILY THERAPIST
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Name | PHYLLIS MILLER PALOMBI
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Credential | M.S.,LPC, LMFT
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Telephone | 703-435-7686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 0701001061
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | PRC13615
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 0717000212
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License Number State | VA
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