Individual
MICHAEL ROBERT FORMICHELLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS
Contact information
Practice address
102 HERITAGE WAY NE STE 302, LEESBURG, VA 20176-4544
(703) 771-5100
(703) 777-0170
Mailing address
102 HERITAGE WAY NE, SUITE 302 PO BOX 7400, LEESBURG, VA 20177-7400
(703) 771-5100
(703) 777-0170
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0701012019
VA
Other
Enumeration date
05/24/2019
Last updated
12/19/2022
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