=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568273837
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROLAND SCHEPPSKE III LPC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2025
-----------------------------------------------------
Last Update Date | 01/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4620 CHERRY HILL RD STE 213
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22207-3418
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-738-5875
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1301 S SCOTT ST APT 702
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22204-6217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-453-6344
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 0701013924
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------