Healthcare Provider Details

I. General information

NPI: 1588309421
Provider Name (Legal Business Name): REDEEMED WAY CHRISTIAN COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2022
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44505 ATWATER DR
ASHBURN VA
20147-3429
US

IV. Provider business mailing address

44691 WELLFLEET DR APT 306
ASHBURN VA
20147-2570
US

V. Phone/Fax

Practice location:
  • Phone: 703-608-8287
  • Fax:
Mailing address:
  • Phone: 703-608-8287
  • 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 Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA MCCARTHY BRODERICK
Title or Position: SOLE MEMBER
Credential: PHD
Phone: 703-608-8287