Provider Demographics
NPI:1609249937
Name:BIRCH, PAUL (MS)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:BIRCH
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10605 JUDICIAL DR STE A1
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-5116
Mailing Address - Country:US
Mailing Address - Phone:703-713-5811
Mailing Address - Fax:
Practice Address - Street 1:10605 JUDICIAL DR STE A1
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030
Practice Address - Country:US
Practice Address - Phone:703-713-5811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-09
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT344780-3902106H00000X
CA70174106H00000X
VA0717001404106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist