Carl Street, LPC

NPI #1720450943 in Bristow, Virginia

Provider Information

NPI Number: 1720450943
Entity Type: Individual
Name: Carl Street, LPC
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Counselor
Credential: LPC
Enumeration Date: Oct 27, 2015
Last Updated: Oct 27, 2015

Practice Location

Address: 11835 HAZEL CIRCLE DR
City: Bristow
State: Virginia
ZIP Code: 20136-2180
Phone: (703) 636-5100

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor	101Y00000X	Primary
Counselor - Addiction (Substance Use Disorder) — Addiction (Substance Use Disorder)	101YA0400X

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