Healthcare Provider Details

I. General information

NPI: 1902735483
Provider Name (Legal Business Name): KATIE ELIZABETH POUNDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20116 ASHBROOK PL STE 110-120
ASHBURN VA
20147-5086
US

IV. Provider business mailing address

1849 FOXSTONE DR
VIENNA VA
22182-2147
US

V. Phone/Fax

Practice location:
  • Phone: 480-660-8757
  • Fax:
Mailing address:
  • Phone: 480-660-8757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0704017190
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: