Provider Demographics
NPI:1497812275
Name:GORMAN, MAUREEN VIRGINIA (MED, LPC)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:VIRGINIA
Last Name:GORMAN
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 ROSZEL RD
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-3831
Mailing Address - Country:US
Mailing Address - Phone:540-722-2156
Mailing Address - Fax:
Practice Address - Street 1:108 W CLIFFORD ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-4058
Practice Address - Country:US
Practice Address - Phone:540-665-1848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA07010204094101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional