Provider Demographics
NPI:1649556184
Name:THERAPY SERVICES AT THE SQUARE, PLLC
Entity type:Organization
Organization Name:THERAPY SERVICES AT THE SQUARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:703-330-3105
Mailing Address - Street 1:11198 LEE HWY
Mailing Address - Street 2:STE D2
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-5008
Mailing Address - Country:US
Mailing Address - Phone:703-330-3105
Mailing Address - Fax:703-621-1128
Practice Address - Street 1:11198 LEE HWY
Practice Address - Street 2:STE D2
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-5008
Practice Address - Country:US
Practice Address - Phone:703-330-3105
Practice Address - Fax:703-621-1128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA081003919103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty