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General NPI Number Information
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NPI Number | 1255969424
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Entity Type | Organization
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Legal Business Name | VIRAGO COUNSELING
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Dates
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Enumeration Date | 04/01/2020
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Last Update Date | 07/27/2022
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Provider Practice Location Address
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Address Line | 5000 THAYER CTR STE C
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City | OAKLAND
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State | MD
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Zip | 21550-1139
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Country | US
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Telephone | 410-656-9353
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Fax |
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Provider Business Mailing Address
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Address Line | 9722 GROFFS MILL DR STE 899
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City | OWINGS MILLS
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State | MD
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Zip | 21117-6341
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Country | US
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Telephone | 410-656-9353
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICAL DIRECTOR
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Name | LEIORA KORTVELY
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Credential | LCSW, LCSW-C, CST,
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Telephone | 410-656-9353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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