Basic Information
| Provider Information | |||||||||
| NPI: | 1629138177 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | O'BEIRNE | ||||||||
| FirstName: | EILEEN | ||||||||
| MiddleName: | GARDNER | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LPC, LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9828 SQUAW VALLEY DR | ||||||||
| Address2: | |||||||||
| City: | VIENNA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221821959 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038386400 | ||||||||
| FaxNumber: | 7038385070 | ||||||||
| Practice Location | |||||||||
| Address1: | 720 N SAINT ASAPH ST | ||||||||
| Address2: | |||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 223141912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038384600 | ||||||||
| FaxNumber: | 7038385070 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 0701001725 | VA | X | Behavioral Health & Social Service Providers | Counselor | Professional | 106H00000X | 0717000838 | VA | X | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | 57810129 | 01 | VA | BLUE CROSS BLUE SHIELD | OTHER | 8500299080 | 01 | VA | AMERIGROUP VIRGINIA INC. | OTHER | 8200187424 | 01 | VA | ANTHEM | OTHER | 546001103002 | 01 | VA | TRICARE | OTHER |