=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851068084
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHEREE CUMBERBATCH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2021
-----------------------------------------------------
Last Update Date | 08/25/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9001 BRADDOCK RD
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22151-1009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-748-5999
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 625 E MONROE AVE APT 224
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22301-3024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-971-3083
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 0730000558
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------