NPIMap

Organization Active NPI

Evidence Based Treatment Collaborative

  • Mental Health Counselor
  • Fairfax, VA
National Provider Identifier
1922858794
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
EVIDENCE BASED TREATMENT COLLABORATIVE
Practice address
4000 Legato Rd FL 11
Fairfax, VA 22033-2892
Phone
(571) 206-1747
NPI assigned
Mar 25, 2024
Last updated
Jul 13, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Authorized official

Name
Dr. Joanna Marino, PHDNPI 1144596958
Title
Ceo
Phone
(571) 477-1611

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU Primary
Clinical Psychologist 103TC0700X NU
Clinical Social Worker 1041C0700X NU

Addresses

Primary practice location

4000 Legato Rd FL 11
Fairfax, VA 22033-2892

Mailing address

4000 Legato Rd FL 11
Fairfax, VA 22033-2892

National Provider Directory

National Provider Directory

Locations

4000 Legato Rd
Fl 11
Fairfax, VA 22033
Phone (571) 206-1747

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1711324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1783900800000",
    "number": "1922858794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 LEGATO RD FL 11",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220332892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 LEGATO RD FL 11",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220332892",
            "telephone_number": "571-206-1747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVIDENCE BASED TREATMENT COLLABORATIVE",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-25",
        "last_updated": "2026-07-13",
        "certification_date": "2026-07-13",
        "status": "A",
        "authorized_official_last_name": "MARINO",
        "authorized_official_first_name": "JOANNA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "571-477-1611",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "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 Jul 13, 2026; 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.