Provider Demographics
NPI:1346764669
Name:GREATER WASHINGTON COUNSELING AND MENTAL HEALTH
Entity Type:Organization
Organization Name:GREATER WASHINGTON COUNSELING AND MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:LIEBERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:301-213-6637
Mailing Address - Street 1:9198 SILVERLINE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX STATION
Mailing Address - State:VA
Mailing Address - Zip Code:22039-3109
Mailing Address - Country:US
Mailing Address - Phone:301-213-6637
Mailing Address - Fax:
Practice Address - Street 1:3900 UNIVERSITY DR STE 320
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2513
Practice Address - Country:US
Practice Address - Phone:301-213-6637
Practice Address - Fax:703-563-9277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-28
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA701006194261QM0801X, 261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA701006194OtherLPC LICENSE NUMBER