Healthcare Provider Details

I. General information

NPI: 1922603158
Provider Name (Legal Business Name): ESTEFANIA CONCEPCION-EBLAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ESTEFANIA CONCEPCION-EBLAN

II. Dates (important events)

Enumeration Date: 12/04/2020
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14150 PARKEAST CIR STE 200
CHANTILLY VA
20151-4212
US

IV. Provider business mailing address

14150 PARKEAST CIR STE 200
CHANTILLY VA
20151-4212
US

V. Phone/Fax

Practice location:
  • Phone: 703-449-6114
  • Fax:
Mailing address:
  • Phone: 703-449-6114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0701009718
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: