Healthcare Provider Details

I. General information

NPI: 1285272146
Provider Name (Legal Business Name): STEPHANIE R MOKEY MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2019
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3931 UNIVERSITY DR
FAIRFAX VA
22030-2506
US

IV. Provider business mailing address

3271 ROSE GLEN CT
FALLS CHURCH VA
22042-3833
US

V. Phone/Fax

Practice location:
  • Phone: 703-349-2999
  • Fax:
Mailing address:
  • Phone: 410-897-2699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701013398
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: