Individual provider Active NPI

Mark Walker

  • Mental Health Counselor
  • Fairfax, VA
National Provider Identifier
1649154584
Registry record updated Aug 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
0704018280 Issued in VA
Practice address
11166 Fairfax Blvd Ste 201
Fairfax, VA 22030-5017
Phone
(703) 988-4236
Fax
(703) 721-7598
NPI assigned
Aug 4, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 0704018280 VA Primary

Addresses

Primary practice location

11166 Fairfax Blvd Ste 201
Fairfax, VA 22030-5017

Mailing address

11166 Fairfax Blvd Ste 201
Fairfax, VA 22030-5017
Phone (703) 988-4236

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
0704018280VAMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Neutral Ground Counseling Group Mental Health CurrentSince Oct 12, 2025 Accepting new patients

Locations

11166 Fairfax Blvd
Ste 201
Fairfax, VA 22030
Phone (703) 977-4576

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1754265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754265600000",
    "number": "1649154584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11166 FAIRFAX BLVD STE 201",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220305017",
            "telephone_number": "703-988-4236",
            "fax_number": "703-721-7598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11166 FAIRFAX BLVD STE 201",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220305017",
            "telephone_number": "703-988-4236",
            "fax_number": "703-721-7598"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALKER",
        "first_name": "MARK",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-08-04",
        "last_updated": "2025-08-04",
        "certification_date": "2025-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "VA",
            "license": "0704018280",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Aug 4, 2025; 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.