Healthcare Provider Details

I. General information

NPI: 1780891432
Provider Name (Legal Business Name): KATHERINE BERGIN ZAEPFEL MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10560 MAIN ST 402
FAIRFAX VA
22030-7182
US

IV. Provider business mailing address

9026 LONGSTREET DR
MANASSAS VA
20110-8830
US

V. Phone/Fax

Practice location:
  • Phone: 703-359-0460
  • Fax:
Mailing address:
  • Phone: 703-392-6775
  • Fax: 703-392-6775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0904002325
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: