Provider Demographics
NPI:1548379423
Name:MCDONALD, SIRI D (MA, LPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:SIRI
Middle Name:D
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:687 WHITMER RD
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH JUNCTION
Mailing Address - State:WV
Mailing Address - Zip Code:25442-4738
Mailing Address - Country:US
Mailing Address - Phone:703-554-3914
Mailing Address - Fax:
Practice Address - Street 1:102 HERITAGE WAY NE STE 302
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-4544
Practice Address - Country:US
Practice Address - Phone:703-771-5963
Practice Address - Fax:703-777-0170
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
VA0701004640101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAMSC # 77AOtherMAILSTOP-EMPLOYER ID
VA503OtherPROVIDER ID - EMPLOYER