Healthcare Provider Details

I. General information

NPI: 1134059025
Provider Name (Legal Business Name): IMANI DEEN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4850 MARK CENTER DR
ALEXANDRIA VA
22311-1882
US

IV. Provider business mailing address

17961 WOODS VIEW DR
DUMFRIES VA
22026-2781
US

V. Phone/Fax

Practice location:
  • Phone: 703-746-5700
  • Fax:
Mailing address:
  • Phone: 571-294-4884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701015952
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: