Provider Demographics
NPI:1316024425
Name:PRINCE WILLIAM FAMILY COUNSELING, P.C.
Entity Type:Organization
Organization Name:PRINCE WILLIAM FAMILY COUNSELING, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL NURSE SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:AIDA
Authorized Official - Middle Name:FALINE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, BC
Authorized Official - Phone:703-330-9933
Mailing Address - Street 1:9625 SURVEYOR CT
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4422
Mailing Address - Country:US
Mailing Address - Phone:703-330-9933
Mailing Address - Fax:
Practice Address - Street 1:9625 SURVEYOR CT
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4422
Practice Address - Country:US
Practice Address - Phone:703-330-9933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA364SP0809X364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, AdultGroup - Multi-Specialty