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General NPI Number Information
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NPI Number | 1699074435
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Entity Type | Organization
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Legal Business Name | RED CEDAR COUNSELING, PLLC
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Dates
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Enumeration Date | 03/18/2011
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Last Update Date | 03/18/2011
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Provider Practice Location Address
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Address Line | 20755 RED CEDAR DRIVE PROFESSIONAL COUNSELING DEPARTMENT
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City | LEESBURG
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State | VA
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Zip | 20175-8787
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Country | US
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Telephone | 703-829-3752
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Fax |
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Provider Business Mailing Address
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Address Line | 20755 RED CEDAR DRIVE PROFESSIONAL COUNSELING DEPARTMENT
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City | LEESBURG
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State | VA
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Zip | 20175-8787
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Country | US
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Telephone | 703-829-3752
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF CLINICAL SERVICES
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Name | MRS. LIZBETH SAM
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Credential | LPC
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Telephone | 703-829-3752
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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 | 0701004060
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License Number State | VA
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