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General NPI Number Information
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NPI Number | 1346764669
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Entity Type | Organization
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Legal Business Name | GREATER WASHINGTON COUNSELING AND MENTAL HEALTH
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Dates
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Enumeration Date | 07/28/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 3900 UNIVERSITY DR STE 320
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City | FAIRFAX
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State | VA
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Zip | 22030-2513
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Country | US
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Telephone | 301-213-6637
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Fax | 703-563-9277
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Provider Business Mailing Address
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Address Line | 9198 SILVERLINE DR
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City | FAIRFAX STATION
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State | VA
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Zip | 22039-3109
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Country | US
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Telephone | 301-213-6637
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. MICHAEL C LIEBERMAN
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Credential | LPC
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Telephone | 301-213-6637
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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 | 701006194
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 701006194
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 701006194
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License Number State | VA
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