Individual
ANTHONY KOCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSYD, LCP, LPC, NCC
Contact information
Practice address
2740 PROSPERITY AVE STE 200, FAIRFAX, VA 22031-4354
(703) 321-2600
Mailing address
9450 FAIRFAX BLVD APT 1433, FAIRFAX, VA 22031-2421
(540) 219-9608
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
0701011884
VA
101YP2500X
Professional Counselor
PC012077
PA
103TC0700X
Clinical Psychologist
Primary
0810008334
VA
Other
Enumeration date
02/20/2018
Last updated
11/09/2023
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