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Provider Information for 1437729381


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OLIVIA WITHERS LPC, LCPC


Sex: Female

NPI: 1437729381
Last Updated: 2024-04-17
Certification Date: 2024-04-17

Details

NameValue
NPI1437729381
Enumeration Date2021-07-01
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
Mailing Address 10513 JUDICIAL DR STE 101
FAIRFAX, VA 22030-7528
United States

Phone: 301-200-1999 | Fax:
 
Primary Practice Address 10513 JUDICIAL DR STE 101
FAIRFAX, VA 22030-7528
United States

Phone: 301-200-1999 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 101YP2500X - Counselor - ProfessionalVA0701010599
No 101YM0800X - Counselor - Mental HealthVA0701010599
No 101YM0800X - Counselor - Mental HealthMDLC15022
No 101YP2500X - Counselor - ProfessionalMDLC15022