MEDICARE: MOSAIC COUNSELING CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1811562358
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOSAIC COUNSELING CENTER LLC

Provider Business Mailing Address
First Line	:	385 GARRISONVILLE RD STE 113
Second Line	:
City	:	STAFFORD
State	:	VA
Zip	:	22554-8900
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	385 GARRISONVILLE RD STE 113
Second Line	:
City	:	STAFFORD
State	:	VA
Zip	:	22554-8900
Country	:	US
Telephone Number	:	540-419-8902
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JAMES KASTEN
Credential	:	LPC
Telephone Number	:	703-895-0053

Provider Enumeration Date	:	05/26/2021
Last Update Date	:	05/26/2021

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