Provider Demographics
NPI:1033260906
Name:WARD, MICHELLE R (LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:R
Last Name:WARD
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12825 YATES FORD RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:VA
Mailing Address - Zip Code:20124-1820
Mailing Address - Country:US
Mailing Address - Phone:703-200-8205
Mailing Address - Fax:
Practice Address - Street 1:10381 MAIN ST FL 2
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2455
Practice Address - Country:US
Practice Address - Phone:703-200-8205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA74-3162023101YP2500X
VA0701003846101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional