Provider Demographics
NPI:1164596136
Name:VIRAK, KATHERINE MILAN (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MILAN
Last Name:VIRAK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 555
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-0555
Mailing Address - Country:US
Mailing Address - Phone:804-717-1111
Mailing Address - Fax:804-717-1185
Practice Address - Street 1:1133 JEFFERSON GREEN CIR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-4300
Practice Address - Country:US
Practice Address - Phone:804-717-1111
Practice Address - Fax:804-717-1185
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA090400198101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA461626OtherANTHEM
VA1033338OtherCIGNA
VA008952752Medicaid
VA008952752Medicaid