Healthcare Provider Details

I. General information

NPI: 1427863612
Provider Name (Legal Business Name): SONIA ATUL GUPTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2025
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3331 DUKE ST
ALEXANDRIA VA
22314-4597
US

IV. Provider business mailing address

1800 CHAIN BRIDGE RD APT 808
MC LEAN VA
22102-2967
US

V. Phone/Fax

Practice location:
  • Phone: 703-552-2722
  • Fax:
Mailing address:
  • Phone: 240-604-3236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0704015507
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: