Individual
MIKI NISHIDA GOERDT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2916 LAWRENCE DR, FALLS CHURCH, VA 22042-1405
(703) 829-6350
Mailing address
2916 LAWRENCE DR, FALLS CHURCH, VA 22042-1405
(703) 829-6350
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0904007089
VA
1041C0700X
Clinical Social Worker
0904007089
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0904007089
VA SOCIAL WORK LICENES
VA
Enumeration date
01/28/2014
Last updated
08/29/2020
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