Provider Demographics
NPI:1699074435
Name:RED CEDAR COUNSELING, PLLC
Entity type:Organization
Organization Name:RED CEDAR COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:LIZBETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SAM
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:703-829-3752
Mailing Address - Street 1:20755 RED CEDAR DRIVE
Mailing Address - Street 2:PROFESSIONAL COUNSELING DEPARTMENT
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-8787
Mailing Address - Country:US
Mailing Address - Phone:703-829-3752
Mailing Address - Fax:
Practice Address - Street 1:20755 RED CEDAR DRIVE
Practice Address - Street 2:PROFESSIONAL COUNSELING DEPARTMENT
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-8787
Practice Address - Country:US
Practice Address - Phone:703-829-3752
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-18
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004060101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty