| Occoquan Counseling, Llc | |
|
12866 Harbor Dr Woodbridge VA 22192-2921 | |
| (703) 494-4164 | |
| (703) 563-9304 |
| Full Name | Occoquan Counseling, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 12866 Harbor Dr, Woodbridge, Virginia |
| Authorized Official Name and Position | Kelly Facciola (MEMBER/MANAGER) |
| Authorized Official Contact | 7032037535 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Occoquan Counseling, Llc 12866 Harbor Dr Woodbridge VA 22192-2921 Ph: (703) 203-7535 | Occoquan Counseling, Llc 12866 Harbor Dr Woodbridge VA 22192-2921 Ph: (703) 494-4164 |
| NPI Number | 1780834911 |
|---|---|
| Provider Enumeration Date | 09/24/2008 |
| Last Update Date | 04/27/2018 |
| Medicare PECOS PAC ID | 0446327647 |
|---|---|
| Medicare Enrollment ID | O20080929000715 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780834911 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 0904005064 (Virginia) | Primary |
| Provider Name | Kelly L Facciola |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598873101 PECOS PAC ID: 5991872194 Enrollment ID: I20080929000711 |
| Provider Name | Sonya Lynn Bryce |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1649216854 PECOS PAC ID: 7315383981 Enrollment ID: I20240306002307 |
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