NPIMap

Organization Active NPI

Lifespan Counseling Services, LLC

  • Clinical Social Worker
  • Fairfax, VA
National Provider Identifier
1407173248
Registry record updated Apr 29, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
0904006801 Issued in VA
Legal business name
LIFESPAN COUNSELING SERVICES, LLC
Practice address
8500 Executive Park Ave Ste 204
Fairfax, VA 22031-2253
Phone
(703) 876-8480
NPI assigned
May 3, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2015

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

Authorized official

Name
Ms. Danielle C Nicholson, LCSW
Title
Social Worker
Phone
(703) 490-9681

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X 0904006801 VA Primary

Addresses

Primary practice location

8500 Executive Park Ave Ste 204
Fairfax, VA 22031-2253

Mailing address

5104 Coleridge Dr
Fairfax, VA 22032-2420
Phone (703) 965-8712

Other identifiers 1

IdentifierTypeStateIssuer
12093630OtherVACAQH

National Provider Directory

National Provider Directory

Locations

8500 Executive Park Ave
Ste 204
Fairfax, VA 22031
Phone (703) 876-8480

Practitioners & affiliated clinicians

Practitioners 9

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": "1272844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430265600000",
    "number": "1407173248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5104 COLERIDGE DR",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220322420",
            "telephone_number": "703-965-8712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8500 EXECUTIVE PARK AVE STE 204",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220312253",
            "telephone_number": "703-876-8480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESPAN COUNSELING SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-03",
        "last_updated": "2015-04-29",
        "status": "A",
        "authorized_official_last_name": "NICHOLSON",
        "authorized_official_first_name": "DANIELLE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "SOCIAL WORKER",
        "authorized_official_telephone_number": "703-490-9681",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904006801",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "12093630",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Apr 29, 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.