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General NPI Number Information
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NPI Number | 1881752582
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Entity Type | Individual
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Provider Name | TRACY GINTER BUSHKOFF ED.D., LPC
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Gender | Female
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3801 FAIRFAX DR STE 62
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City | ARLINGTON
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State | VA
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Zip | 22203-1762
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Country | US
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Telephone | 703-243-3432
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Fax | 703-532-2787
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Provider Business Mailing Address
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Address Line | 3804 N TAZEWELL ST
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City | ARLINGTON
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State | VA
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Zip | 22207-4556
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Country | US
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Telephone | 703-243-3432
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Fax | 703-532-2787
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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 | 0701001581
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License Number State | VA
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