New Client Forms

New Client Forms are the forms that I ask new clients to complete.  My introductory letter explains  which forms should be completed when.  Most importantly, if you are relying on insurance to pay for your work with me, please be sure to call your insurance company to verify your benefits.  You may be asked the following information about me:

EIN:  81-4806419
NPI:  1336534007
MD LCPC license:  LC5264
VA LPC license:  0701007349
MD practice location: 13240 Executive Park Terrace, Germantown, MD 20874
VA practice location: 512 Herndon Parkway, Suite F, Herndon, VA 20170

If you would like my billing company to verify your benefits before your first appointment, please fax the New Client Information Form and a copy of your insurance card to me at 703-552-1317.