Active NPI
Patricia Ann Suppes
- Counselor
- Fairfax, VA
National Provider Identifier
1679899983
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 0701004764
- Practice address
- 11204 Waples Mill Rd
Fairfax, VA 22030-6036 - Phone
- (703) 218-8518
- NPI assigned
- Apr 12, 2010
- Last updated
- Apr 12, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 0701004764 | VA | Primary |
Addresses
Primary practice location
11204 Waples Mill Rd
Fairfax, VA 22030-6036
Mailing address
405 Tennessee Ave
Alexandria, VA 22305-1329
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
| License | State | Type | Specialty |
|---|---|---|---|
| 0701004764 | VA | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1271030400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1271030400000",
"number": "1679899983",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "405 TENNESSEE AVE",
"city": "ALEXANDRIA",
"state": "VA",
"postal_code": "223051329"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11204 WAPLES MILL RD",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "220306036",
"telephone_number": "703-218-8518"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUPPES",
"first_name": "PATRICIA",
"middle_name": "ANN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-04-12",
"last_updated": "2010-04-12",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "VA",
"license": "0701004764",
"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 Apr 12, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.