NPIMap

Organization Active NPI

Open Bridges Counseling, LLC

  • Clinical Social Worker
  • Fairfax, VA
National Provider Identifier
1346589587
Registry record updated Jan 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
0904006259 Issued in VA
Legal business name
OPEN BRIDGES COUNSELING, LLC
Practice address
10400 Eaton Place
Ste 200
Fairfax, VA 22030
Phone
(703) 591-5912
Fax
(703) 591-7210
NPI assigned
Feb 7, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2020

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

Authorized official

Name
Mrs. Irene Carol Ilachinski, LCSW
Title
Owner/Licensed Clinical Social Work
Phone
(703) 591-5912

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X 0904006259 VA Primary

Addresses

Primary practice location

10400 Eaton Place
Ste 200
Fairfax, VA 22030

Mailing address

10400 Eaton Place
Ste 200
Fairfax, VA 22030
Phone (703) 591-5912

Other identifiers 1

IdentifierTypeStateIssuer
01013047083MedicaidVA

Other names 1

  • Irene Ilachinski, LCSW Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1360195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579824000000",
    "number": "1346589587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10400 EATON PLACE",
            "address_2": "STE 200",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "22030",
            "telephone_number": "703-591-5912",
            "fax_number": "703-591-7210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10400 EATON PLACE",
            "address_2": "STE 200",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "22030",
            "telephone_number": "703-591-5912",
            "fax_number": "703-591-7210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPEN BRIDGES COUNSELING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-07",
        "last_updated": "2020-01-24",
        "certification_date": "2020-01-24",
        "status": "A",
        "authorized_official_last_name": "ILACHINSKI",
        "authorized_official_first_name": "IRENE",
        "authorized_official_middle_name": "CAROL",
        "authorized_official_title_or_position": "OWNER/LICENSED CLINICAL SOCIAL WORK",
        "authorized_official_telephone_number": "703-591-5912",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904006259",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01013047083",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Irene Ilachinski, LCSW",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fairfax, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2020; 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.