Provider Demographics
NPI:1619103140
Name:DURANT, EARL R (LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:EARL
Middle Name:R
Last Name:DURANT
Suffix:
Gender:M
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11250 ROGER BACON DR
Mailing Address - Street 2:SUITE 12
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5219
Mailing Address - Country:US
Mailing Address - Phone:703-437-9993
Mailing Address - Fax:703-437-9975
Practice Address - Street 1:11250 ROGER BACON DR
Practice Address - Street 2:SUITE 12
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5219
Practice Address - Country:US
Practice Address - Phone:703-437-9993
Practice Address - Fax:703-437-9975
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001747101YP2500X
VA0717000693106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0701001747OtherLICENSED PROFESSIONAL COUNSELOR
VA0717000693OtherLICENSED MARRIAGE AND FAMILY THERAPIST