Provider Demographics
NPI:1083742548
Name:BUKAS, BART M (LPC)
Entity Type:Individual
Prefix:MR
First Name:BART
Middle Name:M
Last Name:BUKAS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N WASHINGTON ST
Mailing Address - Street 2:SUITE 238
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-4523
Mailing Address - Country:US
Mailing Address - Phone:703-534-1401
Mailing Address - Fax:703-534-1403
Practice Address - Street 1:100 N WASHINGTON ST
Practice Address - Street 2:SUITE 238
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-4523
Practice Address - Country:US
Practice Address - Phone:703-534-1401
Practice Address - Fax:703-534-1403
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002910101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAN210OtherCAREFIRST BC BS PIN