Provider Demographics
NPI:1790031854
Name:BETHEA, MAUREEN SMITH (LMFT)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:SMITH
Last Name:BETHEA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:CONNELL
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10640 PAGE AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-4000
Mailing Address - Country:US
Mailing Address - Phone:703-744-0609
Mailing Address - Fax:
Practice Address - Street 1:10640 PAGE AVE STE 210
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4000
Practice Address - Country:US
Practice Address - Phone:704-614-2388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-26
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717001248106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist