Provider Demographics
NPI:1154417087
Name:MCDONALD, BRIAN R (PHD, LPC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:R
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 DUKE ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-3648
Mailing Address - Country:US
Mailing Address - Phone:703-629-3248
Mailing Address - Fax:
Practice Address - Street 1:919 DUKE STREET
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-6122
Practice Address - Country:US
Practice Address - Phone:703-629-3248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003819101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional