Provider Demographics
NPI:1487742615
Name:UMAN, LAWRENCE (MA)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:UMAN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 WAINWRIGHT DR
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-3429
Mailing Address - Country:US
Mailing Address - Phone:703-868-5947
Mailing Address - Fax:
Practice Address - Street 1:1616 WAINWRIGHT DR
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3429
Practice Address - Country:US
Practice Address - Phone:703-868-5947
Practice Address - Fax:703-391-7381
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VALMFT 0717000267106H00000X
VALPC 0701002320101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist