Healthcare Provider Details

I. General information

NPI: 1982051702
Provider Name (Legal Business Name): DENEE DANIEL MA, CSAC, LPC-R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DENEE PETERS CSAC

II. Dates (important events)

Enumeration Date: 05/22/2016
Last Update Date: 07/26/2026
Certification Date: 07/26/2026
Deactivation Date: 05/25/2020
Reactivation Date: 07/22/2026

III. Provider practice location address

11166 FAIRFAX BLVD STE 500
FAIRFAX VA
22030-5017
US

IV. Provider business mailing address

11166 FAIRFAX BLVD STE 500
FAIRFAX VA
22030-5017
US

V. Phone/Fax

Practice location:
  • Phone: 571-441-3028
  • Fax:
Mailing address:
  • Phone: 571-441-3028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0704007272
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0710102684
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: