Provider Demographics
NPI:1154056836
Name:VIRES, MICHAEL (LGPC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:VIRES
Suffix:
Gender:M
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17711 GLOBE THEATRE DR
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1676
Mailing Address - Country:US
Mailing Address - Phone:301-706-4375
Mailing Address - Fax:
Practice Address - Street 1:2205 WARWICK WAY STE 100
Practice Address - Street 2:
Practice Address - City:MARRIOTTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21104-1631
Practice Address - Country:US
Practice Address - Phone:240-883-6847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP12753101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor