Provider Demographics
NPI:1205109055
Name:PRIOR, RANDALL LEAVITT (DMIN)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:LEAVITT
Last Name:PRIOR
Suffix:
Gender:M
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX QQ
Mailing Address - Street 2:CENTER FOR PASTORAL COUNSELING OF VIRGINIA
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-0700
Mailing Address - Country:US
Mailing Address - Phone:703-903-9696
Mailing Address - Fax:
Practice Address - Street 1:10723 MAIN ST
Practice Address - Street 2:FAIRFAX PRESBYTERIAN CHURCH
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6905
Practice Address - Country:US
Practice Address - Phone:703-270-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101Y00000XBehavioral Health & Social Service ProvidersCounselor