Provider Demographics
NPI:1871752030
Name:KACHURA, MICHAEL JOHN (LPC; LMFT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JOHN
Last Name:KACHURA
Suffix:
Gender:M
Credentials:LPC; LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 OLD LEE HWY
Mailing Address - Street 2:SUITE 52A
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2426
Mailing Address - Country:US
Mailing Address - Phone:703-385-7575
Mailing Address - Fax:703-385-7578
Practice Address - Street 1:3925 OLD LEE HWY
Practice Address - Street 2:SUITE 52A
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2426
Practice Address - Country:US
Practice Address - Phone:703-385-7575
Practice Address - Fax:703-385-7578
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001253101YP2500X
VA0717000346106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist