Provider Demographics
NPI:1336258052
Name:MENDOZA, CATHERINE MCGLAUN (LPC)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:MCGLAUN
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CATHY
Other - Middle Name:HAYES
Other - Last Name:MCGLAUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:3178 JADWYN RD
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22664-2908
Mailing Address - Country:US
Mailing Address - Phone:540-335-0660
Mailing Address - Fax:540-459-1739
Practice Address - Street 1:122 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:VA
Practice Address - Zip Code:22664-1423
Practice Address - Country:US
Practice Address - Phone:540-335-0660
Practice Address - Fax:540-459-1739
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003191101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA197831OtherPROVIDER # ANTHEM
VA197831Medicaid