Healthcare Provider Details

I. General information

NPI: 1215228853
Provider Name (Legal Business Name): MELADIE GEY-BURKE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2011
Last Update Date: 10/06/2024
Certification Date: 10/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 N FAIRFAX ST STE 802
ALEXANDRIA VA
22314-1442
US

IV. Provider business mailing address

1199 N FAIRFAX ST STE 802
ALEXANDRIA VA
22314-1442
US

V. Phone/Fax

Practice location:
  • Phone: 703-623-0740
  • Fax:
Mailing address:
  • Phone: 703-623-0740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701004905
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: