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General NPI Number Information
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NPI Number | 1326102799
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Entity Type | Organization
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Legal Business Name | PRINCE WILIAM FAMILY COUNSELING, PC
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 9625 SURVEYOR CT SUITE 200
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City | MANASSAS
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State | VA
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Zip | 20110-4422
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Country | US
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Telephone | 703-330-9933
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Fax | 703-368-8454
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Provider Business Mailing Address
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Address Line | 9625 SURVEYOR CT SUITE 200
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City | MANASSAS
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State | VA
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Zip | 20110-4422
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Country | US
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Telephone | 703-330-9933
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Fax | 703-368-8454
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. HENRY KOCH
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Credential | PSYCHOLOGIST
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Telephone | 703-330-9933
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0904002397
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License Number State | VA
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