Healthcare Provider Details

I. General information

NPI: 1588529119
Provider Name (Legal Business Name): PINKLEAF RELATIONSHIP & MENTAL HEALTH WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3060 WILLIAMS DR STE 3001005
FAIRFAX VA
22031-4667
US

IV. Provider business mailing address

3060 WILLIAMS DR STE 3001005
FAIRFAX VA
22031-4667
US

V. Phone/Fax

Practice location:
  • Phone: 571-540-9258
  • Fax: 703-936-8319
Mailing address:
  • Phone: 571-540-9258
  • Fax: 703-936-8319

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: ELIZABETH GREENE
Title or Position: OWNER/CLINICIAN
Credential: LPC
Phone: 540-840-1593