Provider Demographics
NPI:1952585317
Name:FAMILY COUNSELING OF SPRINGFIELD
Entity Type:Organization
Organization Name:FAMILY COUNSELING OF SPRINGFIELD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BARRY
Authorized Official - Last Name:DOLBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-569-1300
Mailing Address - Street 1:8440 OLD KEENE MILL RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-2302
Mailing Address - Country:US
Mailing Address - Phone:703-569-1300
Mailing Address - Fax:703-569-1972
Practice Address - Street 1:8440 OLD KEENE MILL RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-2302
Practice Address - Country:US
Practice Address - Phone:703-569-1300
Practice Address - Fax:703-569-1972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003357101Y00000X
VA0701003412101Y00000X
VA09040045901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA386763OtherANTHEM BCBS