Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
Y | 101YM0800X | Mental Health Counselor | 0701007147 | VA |
NPI | 1003346941 |
---|---|
Provider Name | Erka Mucaj |
First Address | Leesburg, VA 20176-4544 |
Second Address | Leesburg, VA 20176-4544 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2017 |
Last Update Date | 13/06/2017 |