Provider Demographics
NPI:1639409758
Name:SEIUM, WOLDEGHEBRIEL (RIC COMPREHENSIVE PR)
Entity Type:Individual
Prefix:MR
First Name:WOLDEGHEBRIEL
Middle Name:
Last Name:SEIUM
Suffix:
Gender:M
Credentials:RIC COMPREHENSIVE PR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7419 GRESHAM ST.
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22151
Mailing Address - Country:US
Mailing Address - Phone:703-642-8525
Mailing Address - Fax:703-455-7012
Practice Address - Street 1:7419 GRESHAM ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22151-2910
Practice Address - Country:US
Practice Address - Phone:703-642-8525
Practice Address - Fax:703-455-7012
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004666101YP2500X
DCPRC304101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional