MISS KIRSTEN MARIE LUNDEBERG (NPI# 1710198254) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710198254 |
| Entity Type | Individual |
| Full Name | MISS KIRSTEN MARIE LUNDEBERG |
| Credential | LPC, LMFT |
| Practice Address |
3923 Old Lee Hwy Suite 63d Fairfax VA 22030-2428 |
| Mailing Address |
706 N Armistead St Alexandria VA 22312-2937 |
| Practice Telephone | 7035991478 |
| Mailing Telephone | 7033335328 |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 101Y00000X | Counselor | 0701003520 | VA | Behavioral Health & Social Service Providers |
| X | 106H00000X | Marriage & Family Therapist | 0717001065 | VA | Behavioral Health & Social Service Providers |
| Street Address |
3923 OLD LEE HWY SUITE 63D |
| City | FAIRFAX |
| State | VA |
| Zip Code | 22030-2428 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881695518 | J Lawrence Jamieson | Psychologist | 3923 Old Lee Hwy, Fairfax, VA 22030-2428 | 2005-08-03 |
| 1124407135 | Belite Medical Center | Clinic/Center | 3923 Old Lee Hwy, 61 A, Fairfax, VA 22030-2428 | 2015-05-22 |
| 1861825317 | Thomas John Mulligan | Social Worker | 3923 Old Lee Hwy, Fairfax, VA 22030-2428 | 2013-08-19 |
| 1750558045 | Richard B Rothman | Psychiatry & Neurology | 3923 Old Lee Hwy, Suite 61a, Fairfax, VA 22030-2428 | 2008-05-15 |
| 1649302142 | Nancy Wachtenheim | Specialist | 3923 Old Lee Hwy, #63-d, Fairfax, VA 22030-2428 | 2007-03-10 |
| 1255333944 | Kerry Paul Altman | Psychologist | 3923 Old Lee Hwy, Suite 63 D, Fairfax, VA 22030-2428 | 2005-08-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205449477 | Perry Camp Jr. | Psychologist | 4403 Dixie Hill Rd, Unit 205, Fairfax, VA 22030 | 2020-08-28 |
| 1952940322 | Brightview Fair Oaks, LLC | Alzheimer Center (Dementia Center) | 12725 Lee Highway, Fairfax, VA 22030 | 2020-01-02 |
| 1245871524 | Tori Sprowl | Behavioral Analyst | 10430 Democracy Lane #102b & 103, Fairfax, VA 22030 | 2019-10-08 |
| 1528612124 | Paul Sarigianis | Student in an Organized Health Care Education/Training Program | 10379b Democracy Lane, Fairfax, VA 22030 | 2019-07-31 |
| 1497221303 | Kahak, Inc. | Day Training, Developmentally Disabled Services | 10560 Main Street Suite Ps100, Fairfax, VA 22030 | 2018-10-17 |
| 1689177073 | Shamoona Sharif | Dentist | 11050 Lee Hwy, Fairfax, VA 22030 | 2018-03-13 |
| 1205339538 | Rachael Lee Greene | Social Worker | 4403 Dixie Hill Rd. #206, Fairfax, VA 22030 | 2018-03-13 |
| 1558863027 | Jacqueline Renee Bauer | Skilled Nursing Facility | 10701 Main Street, Fairfax, VA 22030 | 2018-03-01 |
| 1275033607 | Philajo Global LLC | Non-emergency Medical Transport (VAN) | 4521 Billingham Street, Fairfax, VA 22030 | 2018-02-12 |
| 1376050401 | Alexander Harrison | Counselor | 4400 University Drive, Ms 2a2, Fairfax, VA 22030 | 2018-01-10 |
| Find all providers in zip 22030 | ||||
| Taxonomy Code | 101Y00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master’s degree and clinical experience and supervision for licensure or certification. |
| Notes: Sources: Abridged from definitions provided by the National Board of Certified Counselors and the American Association of Pastoral Counselors. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932752219 | Tamika M Archer | Counselor | 10621 Jones St Ste 201b, Fairfax, VA 22030-7511 | 2019-07-16 |
| 1912404757 | Conversations Fairfax Counseling Center, LLC | Counselor | 9900 Main St Ste 201, Fairfax, VA 22031-3907 | 2018-04-09 |
| 1275923484 | Jonathan Murdaugh | Counselor | 1040 Tinker Town Rd, Fairfax, SC 29827-7220 | 2015-01-26 |
| 1063757706 | Michael Louis Searby | Counselor | 10370 Democracy Ln, Fairfax, VA 22030-2522 | 2012-12-06 |
| 1841556420 | Phyllis Q. Robinson | Counselor | 3919 Old Lee Hwy, Suite 83 A, Fairfax, VA 22030-2430 | 2012-04-08 |
| 1164694600 | Ruthann Eileen Long-farias | Counselor | 3615 Chain Bridge Road, Unit I, Fairfax, VA 22030 | 2008-03-25 |
| 1487839262 | Reem Koinis | Counselor | 11309 Bulova Ln, Fairfax, VA 22030-5509 | 2007-12-30 |
| 1588873103 | Sarah Livingston Healy | Counselor | 51 Bothin Rd # A, Fairfax, CA 94930-1445 | 2007-05-21 |
| 1255490439 | Nida M Ittayem | Counselor | 3118 Savoy Dr, Fairfax, VA 22031-1019 | 2006-12-06 |
| 1992812630 | Pamela Kaye Munson | Counselor | 66354 440th St, Fairfax, MN 55332-3017 | 2006-08-25 |
| Find all providers in FAIRFAX | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.