Provider Demographics
NPI:1881872505
Name:FAMILY CENTER COUNSELING
Entity type:Organization
Organization Name:FAMILY CENTER COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLORY
Authorized Official - Middle Name:FOX
Authorized Official - Last Name:DIERKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-998-5606
Mailing Address - Street 1:5691 COLUMBIA PIKE
Mailing Address - Street 2:STE# 200
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22041-2887
Mailing Address - Country:US
Mailing Address - Phone:703-998-5606
Mailing Address - Fax:
Practice Address - Street 1:5691 COLUMBIA PIKE
Practice Address - Street 2:STE# 200
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041-2887
Practice Address - Country:US
Practice Address - Phone:703-998-5606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002996103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1861571507Medicare PIN
VA1861571507Medicare UPIN