MEDICARE: MS. MARY LIVINGSTON AZOY L.P.C., C.P.T.

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
1	101YM0800X	Mental Health Counselor	0701003662	VA

General Provider Information

NPI Number	:	1295871754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY LIVINGSTON AZOY L.P.C., C.P.T.

Provider Business Mailing Address
First Line	:	4427 26TH RD N
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22207-4018
Country	:	US
Telephone Number	:	703-351-5825
Fax Number	:

Provider Business Practice Location Address
First Line	:	4427 26TH RD N
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22207-4018
Country	:	US
Telephone Number	:	703-351-5825
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	07/08/2007

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