Healthcare Provider Details

I. General information

NPI: 1184465072
Provider Name (Legal Business Name): ERNESTO ANTONIO TORRES-PENA LPC
Entity Type: Individual
Gender:
Sole Proprietor: N

Provider Other Name: MONICA ANTONIA TORRES

II. Dates (important events)

Enumeration Date: 06/04/2024
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8221 WILLOW OAKS CORPORATE DR
FAIRFAX VA
22031-4512
US

IV. Provider business mailing address

8221 WILLOW OAKS CORPORATE DR
FAIRFAX VA
22031-4512
US

V. Phone/Fax

Practice location:
  • Phone: 703-383-8500
  • Fax:
Mailing address:
  • Phone: 703-559-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701013635
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: