Individual
MS. MARY TIERNAN BROUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.P.C.
Contact information
Practice address
11333 SUNSET HILLS RD, RESTON, VA 20190-5205
(703) 742-8540
Mailing address
11333 SUNSET HILLS RD, RESTON, VA 20190-5205
(703) 742-8540
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0701001827
VA
101YM0800X
Mental Health Counselor
LCO182
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
088958
BLUE CROSS/BLUE SHIELD
VA
Enumeration date
10/06/2006
Last updated
07/08/2007
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