1184875031 NPI number — CLARISSA REEVES RATHBONE M.ED., LPC

Table of content: CLARISSA REEVES RATHBONE M.ED., LPC (NPI 1184875031)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184875031 NPI number — CLARISSA REEVES RATHBONE M.ED., LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RATHBONE
Provider First Name:
CLARISSA
Provider Middle Name:
REEVES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.ED., LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184875031
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6813 JEREMIAH CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRFAX STATION
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22039-1834
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-425-1434
Provider Business Mailing Address Fax Number:
703-764-0516

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10560 MAIN ST
Provider Second Line Business Practice Location Address:
STE 410
Provider Business Practice Location Address City Name:
FAIRFAX
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22030-7182
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-352-8900
Provider Business Practice Location Address Fax Number:
703-352-9040
Provider Enumeration Date:
10/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  0701004460 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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