Provider Demographics
NPI:1477671949
Name:RIZZO, DOUGLAS LEONARD (LPC)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:LEONARD
Last Name:RIZZO
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 1:3206 GUNSTON RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-2101
Mailing Address - Country:US
Mailing Address - Phone:571-245-9342
Mailing Address - Fax:
Practice Address - Street 1:3206 GUNSTON RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-2101
Practice Address - Country:US
Practice Address - Phone:571-245-9342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2024-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003894101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004945026Medicaid