Healthcare Provider Details

I. General information

NPI: 1811873219
Provider Name (Legal Business Name): LINGYI ZHU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2025
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10301 DEMOCRACY LN STE 302
FAIRFAX VA
22030-2545
US

IV. Provider business mailing address

10301 DEMOCRACY LN STE 302
FAIRFAX VA
22030-2545
US

V. Phone/Fax

Practice location:
  • Phone: 571-977-9734
  • Fax:
Mailing address:
  • Phone: 571-977-9734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0704018355
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: