Provider Demographics
NPI:1497339600
Name:NOGALES, VIRGINIA MARIA (LCPC)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:MARIA
Last Name:NOGALES
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 LONG TRAIL TER
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-7760
Mailing Address - Country:US
Mailing Address - Phone:301-919-9673
Mailing Address - Fax:
Practice Address - Street 1:106 LONG TRAIL TER
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-7760
Practice Address - Country:US
Practice Address - Phone:301-919-9673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC11131101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health