MEDICARE: DR. DOROTHY MARGARET PENNANT LPC, NCC, CSAC, CP

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	321077
2	101YP2500X	Professional Counselor	PRC14962	DC
3	101YA0400X	Addiction (Substance Use Disorder) Counselor	0710102268	VA

General Provider Information

NPI Number	:	1568988228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOROTHY MARGARET PENNANT LPC, NCC, CSAC, CP

Provider Business Mailing Address
First Line	:	133 PARK ST NE
Second Line	:
City	:	VIENNA
State	:	VA
Zip	:	22180-4666
Country	:	US
Telephone Number	:	571-866-3717
Fax Number	:

Provider Business Practice Location Address
First Line	:	133 PARK ST NE
Second Line	:
City	:	VIENNA
State	:	VA
Zip	:	22180-4666
Country	:	US
Telephone Number	:	757-814-7182
Fax Number	:

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

Provider Enumeration Date	:	08/15/2017
Last Update Date	:	04/18/2024

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