Provider Demographics
NPI:1568790624
Name:PASTORAL COUNSELING OF NORTHERN VIRGINIA
Entity Type:Organization
Organization Name:PASTORAL COUNSELING OF NORTHERN VIRGINIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HULME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-449-1944
Mailing Address - Street 1:4094 MAJESTIC LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2104
Mailing Address - Country:US
Mailing Address - Phone:703-449-1944
Mailing Address - Fax:703-356-9119
Practice Address - Street 1:1205 DOLLEY MADISON BLVD
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3019
Practice Address - Country:US
Practice Address - Phone:703-449-1944
Practice Address - Fax:703-356-9119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-01
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717000185106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty