Provider Demographics
NPI:1598040230
Name:DOVE, MIRANDA (MED, EDS, LPC)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:DOVE
Suffix:
Gender:F
Credentials:MED, EDS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8328 HILLTOP AVE
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-5136
Mailing Address - Country:US
Mailing Address - Phone:240-285-7852
Mailing Address - Fax:
Practice Address - Street 1:4201 MARTIN AVE
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3008
Practice Address - Country:US
Practice Address - Phone:703-813-5982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005046101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional