Individual
MRS. THERESA MARIE GEORGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
102 HERITAGE WAY NE, SUITE 302, LEESBURG, VA 20176-4544
(703) 771-5163
Mailing address
102 HERITAGE WAY NE, SUITE 302, LEESBURG, VA 20176-4544
(703) 771-5163
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0701003264
VA
101YM0800X
Mental Health Counselor
0701003264
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
293870
AMERIGROUP
VA
01
—
385153
ANTHEM
VA
01
—
540948306
TRICARE
VA
Enumeration date
08/30/2006
Last updated
03/28/2013
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