Healthcare Provider Details

I. General information

NPI: 1043134901
Provider Name (Legal Business Name): FAITH ELISABETH CARTER-PETERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10721 MAIN ST STE 2400
FAIRFAX VA
22030-6902
US

IV. Provider business mailing address

10721 MAIN ST STE 2400
FAIRFAX VA
22030-6902
US

V. Phone/Fax

Practice location:
  • Phone: 703-270-0225
  • Fax: 703-459-9620
Mailing address:
  • Phone: 703-270-0225
  • Fax: 703-459-9620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0704017959
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: