Provider Demographics
NPI:1114945607
Name:KOHLMANN, PHYLLIS BETH (LPC)
Entity Type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:BETH
Last Name:KOHLMANN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 FREMONT LN
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-7307
Mailing Address - Country:US
Mailing Address - Phone:703-757-0707
Mailing Address - Fax:
Practice Address - Street 1:5319 LEE HWY
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22207-1607
Practice Address - Country:US
Practice Address - Phone:703-532-7954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0718000039101YA0400X
VA0701000524101YP2500X
DCPRC882101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional