| Lifespan Counseling Services, Llc | |
|
8500 Executive Park Ave Ste 204 Fairfax VA 22031-2253 | |
| (703) 876-8480 | |
| Not Available |
| Full Name | Lifespan Counseling Services, Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 8500 Executive Park Ave Ste 204, Fairfax, Virginia |
| Authorized Official Name and Position | Danielle C Nicholson (SOCIAL WORKER) |
| Authorized Official Contact | 7034909681 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifespan Counseling Services, Llc 5104 Coleridge Dr Fairfax VA 22032-2420 Ph: (703) 965-8712 | Lifespan Counseling Services, Llc 8500 Executive Park Ave Ste 204 Fairfax VA 22031-2253 Ph: (703) 876-8480 |
| NPI Number | 1407173248 |
|---|---|
| Provider Enumeration Date | 05/03/2010 |
| Last Update Date | 04/29/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407173248 | NPI | - | NPPES |
| 12093630 | Other | VA | CAQH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 0904006801 (Virginia) | Primary |
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