Healthcare Provider Details

I. General information

NPI: 1477176774
Provider Name (Legal Business Name): INSIGHTFUL COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2020
Last Update Date: 05/20/2020
Certification Date: 05/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 KENMORE AVE STE 701
ALEXANDRIA VA
22304-1306
US

IV. Provider business mailing address

4660 KENMORE AVE STE 701
ALEXANDRIA VA
22304-1306
US

V. Phone/Fax

Practice location:
  • Phone: 571-354-0338
  • Fax:
Mailing address:
  • Phone: 571-354-0338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JANICE PETTY
Title or Position: SOLE PROPRIETOR
Credential:
Phone: 571-354-0338