Provider Demographics
NPI:1235390550
Name:THE COUNSELING CENTER OF NORTHERN VIRGINIA
Entity Type:Organization
Organization Name:THE COUNSELING CENTER OF NORTHERN VIRGINIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIR OF BOARD OF TRUSTEES
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:703-281-6326
Mailing Address - Street 1:2367 HUNTER MILL RD
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22181-3005
Mailing Address - Country:US
Mailing Address - Phone:703-281-6326
Mailing Address - Fax:703-242-0331
Practice Address - Street 1:131 PARK ST NE
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4641
Practice Address - Country:US
Practice Address - Phone:703-938-4703
Practice Address - Fax:703-938-4706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717000281106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty