Healthcare Provider Details

I. General information

NPI: 1760118665
Provider Name (Legal Business Name): STILL WATERS COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2022
Last Update Date: 07/25/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3634 VALLEY DR
ALEXANDRIA VA
22302-2032
US

IV. Provider business mailing address

3634 VALLEY DR
ALEXANDRIA VA
22302-2032
US

V. Phone/Fax

Practice location:
  • Phone: 703-867-6782
  • Fax:
Mailing address:
  • Phone: 703-867-6782
  • 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: MRS. HILLARY CLAUSEN
Title or Position: OWNER
Credential: LPC, ATR
Phone: 703-867-6782