Healthcare Provider Details

I. General information

NPI: 1326741042
Provider Name (Legal Business Name): DANIELLE ANN OLMEDO LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 03/22/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10121 WOOD GREEN WAY
BURKE VA
22015-2714
US

IV. Provider business mailing address

10121 WOOD GREEN WAY
BURKE VA
22015-2714
US

V. Phone/Fax

Practice location:
  • Phone: 571-527-7333
  • Fax:
Mailing address:
  • Phone: 571-527-7333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701012310
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: