Healthcare Provider Details

I. General information

NPI: 1386577815
Provider Name (Legal Business Name): MATTHEW UMBRELL
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

3930 PENDER DR STE 350
FAIRFAX VA
22030-0989
US

IV. Provider business mailing address

2805 CLASSIC CT
HERNDON VA
20171-2629
US

V. Phone/Fax

Practice location:
  • Phone: 703-865-8686
  • Fax:
Mailing address:
  • Phone:
  • 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: