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General NPI Number Information
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NPI Number | 1417495375
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Entity Type | Organization
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Legal Business Name | MCLEAN COUNSELING CENTER
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Dates
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Enumeration Date | 02/10/2017
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Last Update Date | 12/20/2021
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Provider Practice Location Address
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Address Line | 1307 VINCENT PLACE
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City | MCLEAN
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State | VA
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Zip | 22101
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Country | US
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Telephone | 703-821-1073
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Fax | 703-288-0767
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Provider Business Mailing Address
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Address Line | 1307 VINCENT PLACE
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City | MCLEAN
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State | VA
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Zip | 22101
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Country | US
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Telephone | 703-821-1073
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Fax | 703-288-0767
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | EHSAN HABIBPOUR
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Credential | M.D.
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Telephone | 214-228-9304
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1053467084
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 1659509198
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 1053467084
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 103TF0000X
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Taxonomy Name | Family Psychologist
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License Number | 1659509198
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License Number State | VA
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Taxonomy #5
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 1396942603
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License Number State | VA
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Taxonomy #6
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 1396942603
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License Number State | VA
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