The Center for Self-Development, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

0701004125 Issued in VA

Legal business name

THE CENTER FOR SELF-DEVELOPMENT, LLC

Practice address

2 Pidgeon Hill Dr
Suite 450
Sterling, VA 20165-6145

Phone

(703) 433-1553

Fax

(703) 433-1558

NPI assigned

Dec 3, 2015

Organization subpart

Yes

Parent organization

THE CENTER FOR SELF-DEVELOPMENT, LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jill Ann Hagen, LPC, LPC

Title

Therapist

Phone

(703) 433-1553

Specialties & licenses 1

Addresses

Other identifiers 1

Part of

The Center for Self-Development LLC

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1449100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449100800000",
    "number": "1053786962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 PIDGEON HILL DR",
            "address_2": "SUITE 450",
            "city": "STERLING",
            "state": "VA",
            "postal_code": "201656145",
            "telephone_number": "703-433-1553",
            "fax_number": "703-433-1558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 PIDGEON HILL DR",
            "address_2": "SUITE 450",
            "city": "STERLING",
            "state": "VA",
            "postal_code": "201656145",
            "telephone_number": "703-433-1553",
            "fax_number": "703-433-1558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE CENTER FOR SELF-DEVELOPMENT, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE CENTER FOR SELF-DEVELOPMENT, LLC",
        "enumeration_date": "2015-12-03",
        "last_updated": "2015-12-03",
        "status": "A",
        "authorized_official_last_name": "HAGEN, LPC",
        "authorized_official_first_name": "JILL",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "THERAPIST",
        "authorized_official_telephone_number": "703-433-1553",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "VA",
            "license": "0701004125",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4945247",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.