Basic Information
| Provider Information | |||||||||
| NPI: | 1336229780 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAYMOND | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | ELAINE | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15215 STREAMSIDE CT | ||||||||
| Address2: | |||||||||
| City: | DUMFRIES | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220253022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037927057 | ||||||||
| FaxNumber: | 7037925699 | ||||||||
| Practice Location | |||||||||
| Address1: | 7969 ASHTON AVE | ||||||||
| Address2: | |||||||||
| City: | MANASSAS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201092885 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037927800 | ||||||||
| FaxNumber: | 7037925699 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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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 | 101YM0800X | 0701002533 | VA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 210245 | 01 | VA | BLUE CROSS BLUE SHIELD | OTHER |