Healthcare Provider Details

I. General information

NPI: 1598416588
Provider Name (Legal Business Name): GHAZAL FALAHATPOUR LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2022
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8221 WILLOW OAKS CORPORATE DR STE 4-420
FAIRFAX VA
22031-4512
US

IV. Provider business mailing address

7902 TYSONS ONE PL UNIT 1804
MC LEAN VA
22102-5231
US

V. Phone/Fax

Practice location:
  • Phone: 703-289-7560
  • Fax: 703-204-9001
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701011177
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: