Individual
CARL STREET
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
11835 HAZEL CIRCLE DR, BRISTOW, VA 20136-2180
(703) 636-5100
Mailing address
14488 SHARPSHINNED DR, GAINESVILLE, VA 20155-5837
(703) 753-7229
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
0701005656
VA
101YA0400X
Addiction (Substance Use Disorder) Counselor
0718000249
VA
Other
Enumeration date
10/27/2015
Last updated
10/27/2015
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