Healthcare Provider Details

I. General information

NPI: 1376431726
Provider Name (Legal Business Name): ANDREA CATACORA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2025
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12587 FAIR LAKES CIR # 406
FAIRFAX VA
22033-3822
US

IV. Provider business mailing address

12587 FAIR LAKES CIR # 406
FAIRFAX VA
22033-3822
US

V. Phone/Fax

Practice location:
  • Phone: 703-596-0487
  • Fax:
Mailing address:
  • Phone: 703-596-0487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: