Healthcare Provider Details

I. General information

NPI: 1912357419
Provider Name (Legal Business Name): MARISA BARBACCIA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14150 PARKEAST CIR
CHANTILLY VA
20151-2295
US

IV. Provider business mailing address

14150 PARKEAST CIR
CHANTILLY VA
20151-2295
US

V. Phone/Fax

Practice location:
  • Phone: 703-968-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701015348
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: