Healthcare Provider Details

I. General information

NPI: 1356957864
Provider Name (Legal Business Name): CONNECT TO CARE COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2020
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 N SAINT ASAPH ST STE G
ALEXANDRIA VA
22314-3110
US

IV. Provider business mailing address

118 N SAINT ASAPH ST STE G
ALEXANDRIA VA
22314-3110
US

V. Phone/Fax

Practice location:
  • Phone: 703-857-5354
  • Fax: 571-601-4607
Mailing address:
  • Phone: 703-857-5354
  • Fax: 571-601-4607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. DEITRA LATRICE FANT
Title or Position: OWNER/CLINICIAN
Credential: MA,NCC,LCPC,LPC
Phone: 703-857-5354