Healthcare Provider Details

I. General information

NPI: 1235672445
Provider Name (Legal Business Name): STACY LIEBOVITZ LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2016
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6901 S VAN DORN ST
ALEXANDRIA VA
22315-3961
US

IV. Provider business mailing address

6901 S VAN DORN ST
ALEXANDRIA VA
22315-3961
US

V. Phone/Fax

Practice location:
  • Phone: 703-313-6300
  • Fax:
Mailing address:
  • Phone: 703-313-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701008297
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberMH14473
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH14473
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: