Healthcare Provider Details

I. General information

NPI: 1376455865
Provider Name (Legal Business Name): EMILY DECKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2026
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 MOUNT VERNON AVE # 5
ALEXANDRIA VA
22305-2640
US

IV. Provider business mailing address

4117 N RANDOLPH ST
ARLINGTON VA
22207-4813
US

V. Phone/Fax

Practice location:
  • Phone: 703-495-2821
  • Fax:
Mailing address:
  • Phone: 703-304-4999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0704019566
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: