Provider Demographics
NPI:1366434169
Name:MURPHY-NEILSON, JANINE M (LPC)
Entity type:Individual
Prefix:
First Name:JANINE
Middle Name:M
Last Name:MURPHY-NEILSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11244 WAPLES MILL RD
Mailing Address - Street 2:SUITE D-1
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6040
Mailing Address - Country:US
Mailing Address - Phone:703-596-4205
Mailing Address - Fax:703-476-7979
Practice Address - Street 1:11244 WAPLES MILL RD
Practice Address - Street 2:SUITE D-1
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6040
Practice Address - Country:US
Practice Address - Phone:703-596-4205
Practice Address - Fax:703-476-7979
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003483101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG846-0001OtherBLUE CROSS PROVIDER #