Provider Demographics
NPI:1508086448
Name:MOTTER, NANCY M (LPC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:M
Last Name:MOTTER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13125 MERCURY LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-3712
Mailing Address - Country:US
Mailing Address - Phone:703-968-6801
Mailing Address - Fax:
Practice Address - Street 1:133 PARK ST NE
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4602
Practice Address - Country:US
Practice Address - Phone:703-281-2657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001724101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB5240023OtherBLUE CROSS BLUE SHIELD PP