Healthcare Provider Details

I. General information

NPI: 1528530946
Provider Name (Legal Business Name): VENISE MARIE DARISME M.A., NCC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/24/2018
Last Update Date: 12/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 S GLEBE RD STE 103
ARLINGTON VA
22204-1671
US

IV. Provider business mailing address

700 S COURTHOUSE RD APT 308
ARLINGTON VA
22204-2161
US

V. Phone/Fax

Practice location:
  • Phone: 703-521-6004
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701008057
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: