Basic Information
| Provider Information | |||||||||
| NPI: | 1902206550 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEBSTER | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3930 PENDER DR STE 350 | ||||||||
| Address2: | |||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220300989 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038658686 | ||||||||
| FaxNumber: | 7038656506 | ||||||||
| Practice Location | |||||||||
| Address1: | 3930 PENDER DR STE 350 | ||||||||
| Address2: | |||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220300989 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038658686 | ||||||||
| FaxNumber: | 7038656506 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2014 | ||||||||
| LastUpdateDate: | 08/13/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 087117 | NY | N | Behavioral Health & Social Service Providers | Counselor | 101YM0800X | 0904010734 | VA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.