Provider Demographics
NPI:1457409609
Name:EZUI, FLORIAN (MS, LPC)
Entity type:Individual
Prefix:MR
First Name:FLORIAN
Middle Name:
Last Name:EZUI
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2182
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20146-9082
Mailing Address - Country:US
Mailing Address - Phone:571-308-3590
Mailing Address - Fax:
Practice Address - Street 1:10195 MAIN ST STE O
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-3415
Practice Address - Country:US
Practice Address - Phone:571-308-3590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007213101YP2500X
CO5963101YP2500X
NE1715101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional