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NPI Code Detail

MEDICARE: ARTHUR DANIEL SQUARE JR. LPC

MEDICARE: ARTHUR DANIEL SQUARE JR. LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor0701008343VA

General Provider Information

NPI Number : 1255983987
Entity Type Code : Individual
Provider Name (Legal Business Name) : ARTHUR DANIEL SQUARE JR. LPC
Provider Business Mailing Address
First Line : PO BOX 2111
Second Line :
City : WOODBRIDGE
State : VA
Zip : 22195-2111
Country : US
Telephone Number : 703-409-7612
Fax Number :
Provider Business Practice Location Address
First Line : 14000 CROWN CT STE 101
Second Line :
City : WOODBRIDGE
State : VA
Zip : 22193-1461
Country : US
Telephone Number : 703-659-9900
Fax Number : 571-285-5686
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2019
Last Update Date : 07/12/2019

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