Healthcare Provider Details

I. General information

NPI: 1851107973
Provider Name (Legal Business Name): SUNNY DAZE CLINICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2024
Last Update Date: 12/04/2024
Certification Date: 11/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 WILSON BLVD, 6TH FL
ARLINGTON VA
22209
US

IV. Provider business mailing address

1104 W BROAD ST # 1079
FALLS CHURCH VA
22046-2114
US

V. Phone/Fax

Practice location:
  • Phone: 540-734-9260
  • Fax:
Mailing address:
  • Phone: 540-734-9260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MISS SHAREE HASKINS
Title or Position: FOUNDER/OWNER
Credential: LPC
Phone: 540-734-9260