Provider Demographics
NPI:1982844148
Name:BRUCK, ANITA MARIE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:MARIE
Last Name:BRUCK
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2686 HILLSMAN ST
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22043-3343
Mailing Address - Country:US
Mailing Address - Phone:703-204-1538
Mailing Address - Fax:877-751-2200
Practice Address - Street 1:8296 OLD COURTHOUSE RD
Practice Address - Street 2:SUITE C
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3852
Practice Address - Country:US
Practice Address - Phone:703-855-8320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002572101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional