Healthcare Provider Details

I. General information

NPI: 1104473545
Provider Name (Legal Business Name): SETH YAVIT LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2019
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10560 MAIN ST STE 310
FAIRFAX VA
22030-7175
US

IV. Provider business mailing address

10560 MAIN ST
FAIRFAX VA
22030-7182
US

V. Phone/Fax

Practice location:
  • Phone: 571-277-1771
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPRC15119
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701012997
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: