Provider Demographics
NPI:1982366134
Name:MCCAIN, AUTUMN (LMFT-R)
Entity Type:Individual
Prefix:MRS
First Name:AUTUMN
Middle Name:
Last Name:MCCAIN
Suffix:
Gender:F
Credentials:LMFT-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8223 BAYBERRY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX STATION
Mailing Address - State:VA
Mailing Address - Zip Code:22039-3026
Mailing Address - Country:US
Mailing Address - Phone:703-399-5291
Mailing Address - Fax:
Practice Address - Street 1:12751 MARBLESTONE DR STE 200
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-8337
Practice Address - Country:US
Practice Address - Phone:703-878-3290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist