Healthcare Provider Details

I. General information

NPI: 1912840828
Provider Name (Legal Business Name): TRELLIS THERAPY OF LOUDOUN, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20915 ASHBURN RD STE 215
ASHBURN VA
20147-5678
US

IV. Provider business mailing address

20915 ASHBURN RD STE 215
ASHBURN VA
20147-5678
US

V. Phone/Fax

Practice location:
  • Phone: 703-389-4131
  • Fax:
Mailing address:
  • Phone: 703-389-4131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE BRUESER
Title or Position: FOUNDER/OWNER
Credential: MSW, LCSW
Phone: 703-389-4131