Provider Demographics
NPI:1639354921
Name:BART M BUKAS, MA,LPC,LLC
Entity type:Organization
Organization Name:BART M BUKAS, MA,LPC,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BART
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:BUKAS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:703-534-1401
Mailing Address - Street 1:100 N WASHINGTON ST
Mailing Address - Street 2:SUITE 238
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-4523
Mailing Address - Country:US
Mailing Address - Phone:703-534-1401
Mailing Address - Fax:703-534-1403
Practice Address - Street 1:100 N WASHINGTON ST
Practice Address - Street 2:SUITE 238
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-4523
Practice Address - Country:US
Practice Address - Phone:703-534-1401
Practice Address - Fax:703-534-1403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002910101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAN210OtherCAREFIRST BCBS