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General NPI Number Information
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NPI Number | 1518388537
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Entity Type | Organization
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Legal Business Name | FALLS CHURCH WELLNESS CENTER
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Dates
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Enumeration Date | 12/17/2013
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Last Update Date | 12/17/2013
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Provider Practice Location Address
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Address Line | 300 N WASHINGTON ST SUITE 102
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City | FALLS CHURCH
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State | VA
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Zip | 22046-3438
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Country | US
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Telephone | 703-888-3533
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Fax | 571-364-0075
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Provider Business Mailing Address
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Address Line | 300 N WASHINGTON ST SUITE 102
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City | FALLS CHURCH
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State | VA
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Zip | 22046-3438
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Country | US
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Telephone | 703-888-3533
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Fax | 571-364-0075
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Authorized Official
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Title or Position | CO-OWNER
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Name | THOMAS FREDERICK LAMP
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Credential | LPC
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Telephone | 703-888-3533
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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 | 0701004499
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License Number State | VA
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