Doctor Name: | VIRGINIA REAGAN |
NPI Number: | 1073934030 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | 9040062224 |
Business Practice Address: | 14150 Parkeast Cir Suite 275 Chantilly, VA - 201512295 |
Business Phone Number: | 7034496306 |
Business Fax Number: | 7039684020 |
Mailing Address: | 14150 Parkeast Cir, Suite 275 CHANTILLY |
State: | VA |
Postal Code: | 201512295 |
Phone Number: | 7034496306 |
Fax Number: | 7039684020 |
NPI Enumeration Date: | 12/18/2013 |
NPI Last Update Date: | 12/18/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 9040062224 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |