MEDICARE: MRS. ELIZABETH A J KNUDSON 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	101YP2500X	Professional Counselor	0701011469	VA

General Provider Information

NPI Number	:	1770287922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH A J KNUDSON LPC

Provider Business Mailing Address
First Line	:	10427 NORTH ST STE 201
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22030-2592
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10427 NORTH ST STE 201
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22030-2592
Country	:	US
Telephone Number	:	706-662-9209
Fax Number	:

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

Provider Enumeration Date	:	03/29/2023
Last Update Date	:	03/29/2023

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