=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306905344
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VIRGINIA MARIA HUICI MA, LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 501 CHURCH ST NE SUITE # 206
-----------------------------------------------------
City | VIENNA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22180-4734
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-503-9520
-----------------------------------------------------
Fax | 703-255-2482
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9520 BACCARAT DR
-----------------------------------------------------
City | FAIRFAX
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22032-1217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-503-7863
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 0701003471
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------