Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 0701002729 | VA |
NPI | 1003908450 |
---|---|
Provider Name | Ms. Carrie Annette Cecca |
First Address | Leesburg, VA 20176-4544 |
Second Address | Leesburg, VA 20176 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 07/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
286660 | ANTHEM (01) | VA |
286661 | ANTHEM (01) | VA |