Provider Demographics
NPI:1295800597
Name:LIPP, DOUGLAS OWEN (PHD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:OWEN
Last Name:LIPP
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 PEACHTREE COURT
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:VA
Mailing Address - Zip Code:20158
Mailing Address - Country:US
Mailing Address - Phone:540-338-7304
Mailing Address - Fax:
Practice Address - Street 1:RIVERSIDE COUNSELING CENTER
Practice Address - Street 2:44084 RIVERSIDE PARKWAY SUITE 240
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176
Practice Address - Country:US
Practice Address - Phone:703-724-0200
Practice Address - Fax:703-724-4093
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003425103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical