Active NPI
Charles Coulter Weaver III, LPC, LMFT
- Marriage & Family Therapist
- Alexandria, VA
National Provider Identifier
1629487111
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 0717000869
- Practice address
- 2924 King St
Alexandria, VA 22302-3512 - Phone
- (703) 475-2221
- Fax
- (703) 684-3407
- NPI assigned
- Aug 8, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 0701001741 | VA | |
| Marriage & Family Therapist | 106H00000X | 0717000869 | VA | Primary |
Addresses
Primary practice location
2924 King St
Alexandria, VA 22302-3512
Mailing address
5616I Ox Rd Unit 194
Fairfax Station, VA 22039-8014
Phone (703) 475-2221
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jun 11, 2024 through Jun 11, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0701001741 | VA | MD | Professional Counselor |
| 0717000869 | VA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1407456000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1662076800000",
"number": "1629487111",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5616I OX RD UNIT 194",
"city": "FAIRFAX STATION",
"state": "VA",
"postal_code": "220398014",
"telephone_number": "703-475-2221",
"fax_number": "703-684-3407"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2924 KING ST",
"city": "ALEXANDRIA",
"state": "VA",
"postal_code": "223023512",
"telephone_number": "703-475-2221",
"fax_number": "703-684-3407"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WEAVER",
"first_name": "CHARLES",
"middle_name": "COULTER",
"name_suffix": "III",
"credential": "LPC, LMFT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-08-08",
"last_updated": "2022-09-02",
"certification_date": "2022-09-02",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "VA",
"license": "0701001741",
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "VA",
"license": "0717000869",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Alexandria, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.