Provider Demographics
NPI:1649307463
Name:ESTERLINE, STANLEY R (LPC, LMFT)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:R
Last Name:ESTERLINE
Suffix:
Gender:M
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12489 ROLOK CT
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-1751
Mailing Address - Country:US
Mailing Address - Phone:703-494-0876
Mailing Address - Fax:
Practice Address - Street 1:14904 JEFF DAVIS HWY
Practice Address - Street 2:SUITE 411
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191
Practice Address - Country:US
Practice Address - Phone:703-490-1833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002401101YP2500X
VA0717000478106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA186817Medicare UPIN