MEDICARE: DOUGLAS EDWARD WARFORD 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
1	101YM0800X	Mental Health Counselor	0701008269	VA

General Provider Information

NPI Number	:	1629612510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS EDWARD WARFORD LPC

Provider Business Mailing Address
First Line	:	9276 THORNWOOD LN
Second Line	:
City	:	MANASSAS
State	:	VA
Zip	:	20110-4629
Country	:	US
Telephone Number	:	540-907-7433
Fax Number	:

Provider Business Practice Location Address
First Line	:	13885 HEDGEWOOD DR STE 245
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193-7931
Country	:	US
Telephone Number	:	703-490-0336
Fax Number	:

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

Provider Enumeration Date	:	11/04/2019
Last Update Date	:	11/04/2019

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