Healthcare Provider Details

I. General information

NPI: 1437999398
Provider Name (Legal Business Name): AUTHENTIC CONNECTIONS COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2024
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44031 PIPELINE PLZ STE 305
ASHBURN VA
20147-5888
US

IV. Provider business mailing address

44031 PIPELINE PLZ STE 305
ASHBURN VA
20147-5888
US

V. Phone/Fax

Practice location:
  • Phone: 703-829-6091
  • Fax:
Mailing address:
  • Phone: 703-829-6091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: CAMERON TERRY
Title or Position: OWNER
Credential: LPC, NCC
Phone: 703-829-6091