Healthcare Provider Details

I. General information

NPI: 1326853037
Provider Name (Legal Business Name): MAGDALENA ESCOBAR MEJIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 EISENHOWER AVE STE 501
ALEXANDRIA VA
22314-4688
US

IV. Provider business mailing address

2121 EISENHOWER AVE STE 501
ALEXANDRIA VA
22314-4688
US

V. Phone/Fax

Practice location:
  • Phone: 540-845-6940
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0704017496
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: