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General NPI Number Information
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NPI Number | 1598040230
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Entity Type | Individual
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Provider Name | MIRANDA DOVE MED, EDS, LPC
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Gender | Female
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Dates
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Enumeration Date | 10/13/2011
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Last Update Date | 10/13/2011
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Provider Practice Location Address
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Address Line | 4201 MARTIN AVE
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City | ANNANDALE
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State | VA
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Zip | 22003-3008
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Country | US
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Telephone | 703-813-5982
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Fax |
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Provider Business Mailing Address
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Address Line | 8328 HILLTOP AVE
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City | VIENNA
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State | VA
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Zip | 22182-5136
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Country | US
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Telephone | 240-285-7852
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701005046
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License Number State | VA
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