Healthcare Provider Details

I. General information

NPI: 1548956568
Provider Name (Legal Business Name): ASHLEY PETERSON COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5680 KING CENTRE DR STE 600
ALEXANDRIA VA
22315-5755
US

IV. Provider business mailing address

5680 KING CENTRE DR STE 600
ALEXANDRIA VA
22315-5755
US

V. Phone/Fax

Practice location:
  • Phone: 571-331-8842
  • Fax:
Mailing address:
  • Phone: 571-331-8842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY PETERSON VINCENT
Title or Position: PSYCHOTHERAPIST/OWNER
Credential: LPC
Phone: 571-331-8842