Provider Demographics
NPI:1962948174
Name:CURTIS, EDWARD LEE III (LPC)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:LEE
Last Name:CURTIS
Suffix:III
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:EDWARD
Other - Middle Name:
Other - Last Name:CURTIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:1850 CAMERON GLEN DR
Mailing Address - Street 2:SUITE 600
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-3363
Mailing Address - Country:US
Mailing Address - Phone:703-481-4159
Mailing Address - Fax:703-435-1961
Practice Address - Street 1:1850 CAMERON GLEN DR
Practice Address - Street 2:SUITE 600
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3363
Practice Address - Country:US
Practice Address - Phone:703-481-4159
Practice Address - Fax:703-435-1961
Is Sole Proprietor?:No
Enumeration Date:2017-01-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006879101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional