Provider Demographics
NPI:1245756782
Name:VYMETAL-TAYLOR, JOHN CONOVER (LPC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:CONOVER
Last Name:VYMETAL-TAYLOR
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2708 S JUNE ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-2253
Mailing Address - Country:US
Mailing Address - Phone:571-379-9154
Mailing Address - Fax:
Practice Address - Street 1:4850 MARK CENTER DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-1882
Practice Address - Country:US
Practice Address - Phone:703-746-6004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007064101YP2500X
VA0711000325101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional