Provider Demographics
NPI:1720114796
Name:MICH, BETH CRAWFORD (LPC)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:CRAWFORD
Last Name:MICH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12629 BUILDERS RD
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-2924
Mailing Address - Country:US
Mailing Address - Phone:571-278-4764
Mailing Address - Fax:
Practice Address - Street 1:12629 BUILDERS RD
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-2924
Practice Address - Country:US
Practice Address - Phone:703-591-2551
Practice Address - Fax:703-591-2563
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003623101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health