Healthcare Provider Details

I. General information

NPI: 1548956196
Provider Name (Legal Business Name): NOVA CLINICAL COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4229 LAFAYETTE CENTER DR STE 1300
CHANTILLY VA
20151-1260
US

IV. Provider business mailing address

4229 LAFAYETTE CENTER DR STE 1300
CHANTILLY VA
20151-1260
US

V. Phone/Fax

Practice location:
  • Phone: 703-682-8215
  • Fax:
Mailing address:
  • Phone: 703-682-8215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE GORDEN
Title or Position: CLINICAL DIRECTOR
Credential:
Phone: 703-682-8215