Provider Demographics
NPI:1356911705
Name:SONG, EUNHEE (QMHP-C)
Entity type:Individual
Prefix:DR
First Name:EUNHEE
Middle Name:
Last Name:SONG
Suffix:
Gender:F
Credentials:QMHP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6775 STONE MAPLE TER
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-5737
Mailing Address - Country:US
Mailing Address - Phone:571-201-0916
Mailing Address - Fax:
Practice Address - Street 1:10560 MAIN ST STE 508
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-7173
Practice Address - Country:US
Practice Address - Phone:571-275-6661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0733008077101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor