Provider Demographics
NPI:1306024914
Name:THE CHILD & FAMILY COUNSELING GROUP, PLC
Entity Type:Organization
Organization Name:THE CHILD & FAMILY COUNSELING GROUP, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROPSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:WIRES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:703-352-3822
Mailing Address - Street 1:3959 PENDER DR
Mailing Address - Street 2:SUITE 320
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6041
Mailing Address - Country:US
Mailing Address - Phone:703-352-3822
Mailing Address - Fax:703-385-8353
Practice Address - Street 1:3959 PENDER DR
Practice Address - Street 2:SUITE 320
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6041
Practice Address - Country:US
Practice Address - Phone:703-352-3822
Practice Address - Fax:703-385-8353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904006205101YM0800X
VA0904000808101YM0800X
VA0810003490103TC0700X
VA0810002990103TC0700X
VA0810003772103TC0700X
VA0810002885103TC0700X
VA0810001681103TC2200X
VA0810003557103TC2200X
VA09040027541041C0700X
VA09040042941041C0700X
VA09040021441041C0700X
VA09040060341041C0700X
VA2202003015235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG00452OtherMEDICARE GROUP NUMBER