Provider Demographics
NPI:1386182236
Name:PEREZ, KATHERINE MICHELE (LPC)
Entity type:Individual
Prefix:MISS
First Name:KATHERINE
Middle Name:MICHELE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11835 HAZEL CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:VA
Mailing Address - Zip Code:20136-2180
Mailing Address - Country:US
Mailing Address - Phone:703-368-7995
Mailing Address - Fax:703-631-4335
Practice Address - Street 1:9720 CAPITAL CT STE 302
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-2051
Practice Address - Country:US
Practice Address - Phone:703-368-7995
Practice Address - Fax:571-364-8913
Is Sole Proprietor?:No
Enumeration Date:2017-02-10
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006660101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional