Provider Demographics
NPI:1669581773
Name:VAZZANA, MICHAEL JOSEPH (LPC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:VAZZANA
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:MR
Other - First Name:MICHAEL
Other - Middle Name:JOSEPH
Other - Last Name:VAZZANA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:222 CATOCTIN CIR SE STE 203
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-3730
Mailing Address - Country:US
Mailing Address - Phone:703-362-7311
Mailing Address - Fax:
Practice Address - Street 1:222 CATOCTIN CIR SE STE 203
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-3730
Practice Address - Country:US
Practice Address - Phone:703-249-9883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X, 101YA0400X
VA0701004508101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)