Provider Demographics
NPI:1164596342
Name:GROSS, MARTHA RACHEL (LPC)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:RACHEL
Last Name:GROSS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:RACHEL
Other - Last Name:KRAUTZ GROSS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5691 COLUMBIA PIKE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22041
Mailing Address - Country:US
Mailing Address - Phone:703-998-5606
Mailing Address - Fax:703-998-5608
Practice Address - Street 1:5691 COLUMBIA PIKE
Practice Address - Street 2:SUITE 200
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041
Practice Address - Country:US
Practice Address - Phone:703-998-5606
Practice Address - Fax:703-998-5608
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003275101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
2122855OtherMAMSI
28110012OtherCARE FIRST