Provider Demographics
NPI:1336105279
Name:QUEVEDO, GLORIA (MA, LPC)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:QUEVEDO
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 FAIRFAX DR
Mailing Address - Street 2:53
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-1762
Mailing Address - Country:US
Mailing Address - Phone:202-641-5329
Mailing Address - Fax:202-526-0110
Practice Address - Street 1:3801 FAIRFAX DR
Practice Address - Street 2:53
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1762
Practice Address - Country:US
Practice Address - Phone:202-641-5329
Practice Address - Fax:202-526-0110
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002903101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7293273OtherAETNA BEHAVIORAL
VA509867669OtherUBH
VA89130013OtherCAREFIRST BCBS
VA005408482Medicaid
VA385442OtherANTHEM
VA293620OtherMAMSI
VA264926000OtherMAGELLAN
VA541598045OtherNCPPO