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General NPI Number Information
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NPI Number | 1629487111
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Entity Type | Individual
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Provider Name | CHARLES COULTER WEAVER III LPC, LMFT
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Gender | Male
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Dates
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Enumeration Date | 08/08/2014
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Last Update Date | 09/02/2022
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Provider Practice Location Address
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Address Line | 2924 KING ST
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City | ALEXANDRIA
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State | VA
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Zip | 22302-3512
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Country | US
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Telephone | 703-475-2221
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Fax | 703-684-3407
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Provider Business Mailing Address
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Address Line | 5616I OX RD UNIT 194
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City | FAIRFAX STATION
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State | VA
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Zip | 22039-8014
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Country | US
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Telephone | 703-475-2221
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Fax | 703-684-3407
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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 | 0701001741
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 0717000869
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License Number State | VA
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