Provider Demographics
NPI:1912083742
Name:KOLAR, STEPHANIE (MA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:KOLAR
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22636 GLENN DR STE 105
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20164-4442
Mailing Address - Country:US
Mailing Address - Phone:703-501-2260
Mailing Address - Fax:
Practice Address - Street 1:22636 GLENN DR STE 105
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20164-4442
Practice Address - Country:US
Practice Address - Phone:703-501-2260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002061101YP2500X
DCPRC13890101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA142592OtherANTHEM BLUE CROSS BLUE SH