Provider Demographics
NPI:1639631161
Name:CALLAGHAN, KARA (LPC)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:CALLAGHAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12359 SUNRISE VALLEY DR STE 320
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-3463
Mailing Address - Country:US
Mailing Address - Phone:703-596-4796
Mailing Address - Fax:703-787-8210
Practice Address - Street 1:12359 SUNRISE VALLEY DR STE 320
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-3463
Practice Address - Country:US
Practice Address - Phone:703-596-4796
Practice Address - Fax:703-787-8210
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008246101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional