Healthcare Provider Details

I. General information

NPI: 1912824780
Provider Name (Legal Business Name): MARLON ESPINOZA-MENDOZA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
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: 540-792-4859
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0704019242
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: