Provider Demographics
NPI:1114112836
Name:CENNAME, KAREN LEE (M ED)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:LEE
Last Name:CENNAME
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4009 N GLEBE RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207-4505
Mailing Address - Country:US
Mailing Address - Phone:703-475-5155
Mailing Address - Fax:
Practice Address - Street 1:102 HERITAGE WAY NE
Practice Address - Street 2:SUITE 302
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-4544
Practice Address - Country:US
Practice Address - Phone:703-771-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor