Provider Demographics
NPI:1255969424
Name:VIRAGO COUNSELING
Entity type:Organization
Organization Name:VIRAGO COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LEIORA
Authorized Official - Middle Name:
Authorized Official - Last Name:KORTVELY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LCSW-C, CST,
Authorized Official - Phone:410-656-9353
Mailing Address - Street 1:9722 GROFFS MILL DR STE 899
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-6341
Mailing Address - Country:US
Mailing Address - Phone:410-656-9353
Mailing Address - Fax:
Practice Address - Street 1:5000 THAYER CTR STE C
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550-1139
Practice Address - Country:US
Practice Address - Phone:410-656-9353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-01
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty