Healthcare Provider Details

I. General information

NPI: 1356086722
Provider Name (Legal Business Name): LAURA ONEILL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2022
Last Update Date: 04/30/2022
Certification Date: 04/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9677 MAIN ST # A-B
FAIRFAX VA
22031-3763
US

IV. Provider business mailing address

9677 MAIN ST STE A-B
FAIRFAX VA
22031-3763
US

V. Phone/Fax

Practice location:
  • Phone: 301-767-1733
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701011439
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: