Healthcare Provider Details

I. General information

NPI: 1497269302
Provider Name (Legal Business Name): FACE IT COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2017
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11325 RANDOM HILLS RD STE 360
FAIRFAX VA
22030-0972
US

IV. Provider business mailing address

12587 FAIR LAKES CIR STE 408
FAIRFAX VA
22033-3822
US

V. Phone/Fax

Practice location:
  • Phone: 703-957-8975
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701004743
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KEISHA B MATTHEWS
Title or Position: CEO/OWNER
Credential: BS MA LCPC LPC ACS
Phone: 703-957-8975