Provider Demographics
NPI:1306354386
Name:SILVA, MARY RHEA (LPC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:RHEA
Last Name:SILVA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:THERESA
Other - Last Name:RHEA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1179 CYPRESS TREE PL
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4135
Mailing Address - Country:US
Mailing Address - Phone:816-547-4453
Mailing Address - Fax:
Practice Address - Street 1:11260 ROGER BACON DR STE 206
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5252
Practice Address - Country:US
Practice Address - Phone:816-547-4453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-12
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017028079101Y00000X
VA0701006707101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor