Northern Virginia Older Adult Counseling
Organization Active NPI Community/Behavioral Health Agency · Fairfax, VA
NPI 1831569896 · NPPES record last updated Feb 4, 2016
Key facts
- NPI
- 1831569896
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Behavioral Health Agency 251S00000X
- License
- 0904006279 (VA)
- Legal business name
- NORTHERN VIRGINIA OLDER ADULT COUNSELING
- Practice address
- 4700 Banting CT
Fairfax, VA 22032-2451 - Phone
- (703) 424-0410
- NPI assigned
- Oct 3, 2015
- Organization subpart
- No
Authorized official
- Name
- Susan M Johnson
- Title
- Partner/Operations Officer
- Phone
- (703) 424-0410
Practitioners 30
-
Jennifer M Denk, LCSW
-
Adele S Denny, MSW, LCSW
-
Christin Dougherty, LCSW
-
Stephanie Clark Martin, LICSW, LCSW
-
Miriam McKain, MARIA
-
Ashley Shanta Mitchell, LCSW
-
Joyce L Montgomery, LCSW
-
Sharon Pago, MSW, LCSW, LICSW
-
Michael Allison Ridge, LCSW
-
Ruth Ann Talley, LCSW
-
Kathleen Taylor, LCSW
-
Lorraine Marie Vrsecky, LCSW
-
Karyn B Walsh, LCSW
-
Marilyn R Gebel-Sitts, LCSW
-
Alicea Ardito, LCSW
-
Brooke Lori Johnson, LCSW
-
Jennifer Lanouette, LCSW
-
Ronald Longo, LCSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in DC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160205000052 | DC | Part B Supplier - Clinic/Group Practice | 5294039608 |
Receives reassigned benefits from 28 practitioners Practice locations: Fairfax, VA |
National Provider Directory
Locations
10615 Judicial Dr
Ste 301
Fairfax, VA 22030
Phone (703) 424-0410
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | 0904006279 | VA | Yes |
Addresses
Primary practice location
4700 Banting CT
Fairfax, VA 22032-2451
Mailing address
4700 Banting CT
Fairfax, VA 22032-2451
Phone (703) 424-0410
Other providers in Fairfax, VA
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- Northern Virginia Nephrology Associates PC
- Northern Virginia OBGYN Associates, LTD.
- Northern Virginia Oncology Group, P.C.
- Northern Virginia Oral and Facial Surgery, LLC
- Northern Virginia Pathology PC
- Northern Virginia Pediatric Orthopaedics PLLC
- Northern Virginia Pelvic Surgery Associates, PC
All providers in Fairfax, VA · Community/Behavioral Health Agency in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 4, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.