Healthcare Provider Details

I. General information

NPI: 1295234904
Provider Name (Legal Business Name): TRIANGLE COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2018
Last Update Date: 02/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44355 PREMIER PLZ STE 120
ASHBURN VA
20147-5050
US

IV. Provider business mailing address

44355 PREMIER PLZ STE 120
ASHBURN VA
20147-5050
US

V. Phone/Fax

Practice location:
  • Phone: 703-495-3123
  • Fax:
Mailing address:
  • Phone: 703-495-3123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: DIANNE H ANDRUZZI
Title or Position: DIRECTOR
Credential: MSW, LCSW
Phone: 703-495-3123