Provider Demographics
NPI:1376865451
Name:GEORGE, SHADI KAMRANI (MA, LPC)
Entity Type:Individual
Prefix:
First Name:SHADI
Middle Name:KAMRANI
Last Name:GEORGE
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:PO BOX 1110
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22038-1110
Mailing Address - Country:US
Mailing Address - Phone:703-218-8506
Mailing Address - Fax:703-359-0463
Practice Address - Street 1:11204 WAPLES MILL RD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6036
Practice Address - Country:US
Practice Address - Phone:703-218-8506
Practice Address - Fax:703-359-0463
Is Sole Proprietor?:No
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004751101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4943902Medicaid