Provider Demographics
NPI:1275868002
Name:KOENIGSBERG, SCOTT ROBERT (LPC)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:ROBERT
Last Name:KOENIGSBERG
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3921 OLD LEE HWY
Mailing Address - Street 2:SUITE 73B
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2429
Mailing Address - Country:US
Mailing Address - Phone:703-636-2888
Mailing Address - Fax:703-991-9161
Practice Address - Street 1:3921 OLD LEE HWY
Practice Address - Street 2:SUITE 73B
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2429
Practice Address - Country:US
Practice Address - Phone:703-636-2888
Practice Address - Fax:703-991-9161
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003223101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional