Lifeworks Outreach Services, Inc.

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

1039-05-001 Issued in VA

Legal business name

LIFEWORKS OUTREACH SERVICES, INC.

Practice address

4300 Ridgewood Center Dr Unit a
Woodbridge, VA 22192-5307

Phone

(703) 580-7210

Fax

(703) 580-7213

NPI assigned

Nov 11, 2011

Organization subpart

No

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

Authorized official

Name

Mrs. Maureen Victoria Fannin, LCSW

Title

Clinical Director/Owner

Phone

(703) 580-7210

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Hilary Henegan Cohen, LCSW

  • Clinical Social Worker
  • Woodbridge, VA
  • NPI 1457604084
  NPD (past)

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

{
    "created_epoch": "1320969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320969600000",
    "number": "1962789495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4300 RIDGEWOOD CENTER DR UNIT A",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221925307",
            "telephone_number": "703-580-7210",
            "fax_number": "703-580-7213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4300 RIDGEWOOD CENTER DR UNIT A",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221925307",
            "telephone_number": "703-580-7210",
            "fax_number": "703-580-7213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFEWORKS OUTREACH SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-11",
        "last_updated": "2011-11-11",
        "status": "A",
        "authorized_official_last_name": "FANNIN",
        "authorized_official_first_name": "MAUREEN",
        "authorized_official_middle_name": "VICTORIA",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR/OWNER",
        "authorized_official_telephone_number": "703-580-7210",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "VA",
            "license": "1039-05-001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Woodbridge, VA
• Providers in Woodbridge, 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 Nov 11, 2011; 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.