MEDICARE: MS. CYNTHIA L ZORN-PETTIGREW L..C.S.W.

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	0904002983	VA

General Provider Information

NPI Number	:	1841410271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CYNTHIA L ZORN-PETTIGREW L..C.S.W.

Provider Business Mailing Address
First Line	:	15061 GALAPAGOS PL
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193-5842
Country	:	US
Telephone Number	:	703-730-5227
Fax Number	:	703-368-8454

Provider Business Practice Location Address
First Line	:	12721 DARBY BROOK CT
Second Line	:	SUITE 102
City	:	WOODBRIDGE
State	:	VA
Zip	:	22192-2408
Country	:	US
Telephone Number	:	703-497-1771
Fax Number	:	703-497-1225

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

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	07/08/2007

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