Healthcare Provider Details

I. General information

NPI: 1508090036
Provider Name (Legal Business Name): STEPHANIE REBECCA RYAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2009
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
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: 703-559-3000
  • Fax:
Mailing address:
  • Phone: 703-559-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701004571
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0701004571
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701004571
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: