Agape Mental Health and Consulting

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0904003313 Issued in VA

Legal business name

AGAPE MENTAL HEALTH AND CONSULTING

Practice address

3095 P. S. Business Center Drive
Woodbridge, VA 22192

Phone

(703) 309-3031

NPI assigned

Aug 5, 2006

Organization subpart

No

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

Authorized official

Name

Ms. Fay Marshall Phillips-Lesane, MSW

Title

Owner/Therapist

Phone

(703) 309-3031

Specialties & licenses 1

Addresses

Other identifiers 5

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479081600000",
    "number": "1679582308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4986",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221944986",
            "telephone_number": "703-309-3031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3095 P. S. BUSINESS CENTER DRIVE",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "22192",
            "telephone_number": "703-309-3031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGAPE MENTAL HEALTH AND CONSULTING",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-05",
        "last_updated": "2016-11-14",
        "status": "A",
        "authorized_official_last_name": "PHILLIPS-LESANE",
        "authorized_official_first_name": "FAY",
        "authorized_official_middle_name": "MARSHALL",
        "authorized_official_title_or_position": "OWNER/THERAPIST",
        "authorized_official_telephone_number": "703-309-3031",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904003313",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008939152",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "301819",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS",
            "identifier": "110630",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BC/ BS",
            "identifier": "187248",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST",
            "identifier": "M283001",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Woodbridge, VA
• Providers in Woodbridge, VA by specialty
• Clinical Social Worker in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2016; 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.