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General NPI Number Information
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NPI Number | 1831680214
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Entity Type | Individual
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Provider Name | RADKA LOUCKA LPC
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Gender | Female
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Dates
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Enumeration Date | 05/22/2018
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 2124 JEFFERSON DAVIS HIGHWAY SUITE 202
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City | STAFFORD
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State | VA
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Zip | 22554
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Country | US
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Telephone | 540-426-9700
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Fax | 540-699-6938
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Provider Business Mailing Address
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Address Line | 11 HOPE ROAD SUITE 111, P.O. BOX 222
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City | STAFFORD
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State | VA
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Zip | 22554
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Country | US
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Telephone | 540-426-9700
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Fax | 540-699-6938
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0701007592
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License Number State | VA
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