Provider Demographics
NPI:1558802033
Name:LIEBERMAN, MICHAEL CHARLES (LPC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:CHARLES
Last Name:LIEBERMAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5243 MONROE DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22151-3740
Mailing Address - Country:US
Mailing Address - Phone:301-213-6637
Mailing Address - Fax:
Practice Address - Street 1:7620 LITTLE RIVER TPKE
Practice Address - Street 2:SUITE 403
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-2620
Practice Address - Country:US
Practice Address - Phone:301-213-6637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006194101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional