Maya Martinova Radoslavova

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

0704016703 Issued in VA

Practice address

Ellie Mental Health
10301 Democracy Lane, Suite 302
Fairfax, VA 22030

Phone

(571) 223-7588

NPI assigned

Feb 8, 2024

Last updated

Feb 8, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1707350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707350400000",
    "number": "1871357079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4600 S FOUR MILE RUN DR APT 739",
            "city": "ARLINGTON",
            "state": "VA",
            "postal_code": "222043564",
            "telephone_number": "571-341-0465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ELLIE MENTAL HEALTH",
            "address_2": "10301 DEMOCRACY LANE, SUITE 302",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "22030",
            "telephone_number": "571-223-7588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RADOSLAVOVA",
        "first_name": "MAYA",
        "middle_name": "MARTINOVA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-02-08",
        "last_updated": "2024-02-08",
        "certification_date": "2024-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "VA",
            "license": "0704016703",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Racquel Semeraro Inc.
• Tarynn Radakovic, CCC-SLP
• Barathy Radhakrishnan, SLP
• Radiant Rejuvenation Wellness
• Radiation Oncology Associates, PC
• Andrea Lynn Rafferty, P.T.
• Laura Rafner, COTA/L
• Kimberly Anne Ragan, LCSW
• Susana Rahamatali
• Amal Z Rahhal, MSW

• Mental Health Counselor in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Mental Health Counselor in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2024; 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.