Healthcare Provider Details

I. General information

NPI: 1750519120
Provider Name (Legal Business Name): THE CENTER FOR CLINICAL AND FORENSIC SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2009
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10505 JUDICIAL DR STE 100
FAIRFAX VA
22030-5157
US

IV. Provider business mailing address

10505 JUDICIAL DR STE 100
FAIRFAX VA
22030-5157
US

V. Phone/Fax

Practice location:
  • Phone: 703-278-0457
  • Fax: 703-278-0458
Mailing address:
  • Phone: 703-278-0457
  • Fax: 703-385-1053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. LISA HUNT
Title or Position: PRESIDENT
Credential:
Phone: 703-278-0457