Provider Demographics
NPI:1871361485
Name:RYAN, KATHARINE (LPC)
Entity type:Individual
Prefix:
First Name:KATHARINE
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KATHARINE
Other - Middle Name:
Other - Last Name:RYAN-ROSENBAUM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1497 CHAIN BRIDGE RD STE 205
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-5728
Mailing Address - Country:US
Mailing Address - Phone:703-255-1092
Mailing Address - Fax:
Practice Address - Street 1:1497 CHAIN BRIDGE RD STE 205
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-5728
Practice Address - Country:US
Practice Address - Phone:703-255-1091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006412101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health