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General NPI Number Information
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NPI Number | 1750902342
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Entity Type | Individual
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Provider Name | LORRAINE MARIE VRSECKY LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/05/2020
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Last Update Date | 05/05/2020
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Provider Practice Location Address
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Address Line | 4700 BANTING CT
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City | FAIRFAX
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State | VA
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Zip | 22032-2451
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Country | US
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Telephone | 703-402-2091
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Fax |
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Provider Business Mailing Address
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Address Line | 13621 S SPRINGS DR
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City | CLIFTON
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State | VA
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Zip | 20124-2445
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Country | US
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Telephone | 703-405-5208
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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