Healthcare Provider Details

I. General information

NPI: 1659790079
Provider Name (Legal Business Name): KATHERINE HANNON LCPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2014
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2998 ESKRIDGE RD
FAIRFAX VA
22031-2359
US

IV. Provider business mailing address

2998 ESKRIDGE RD
FAIRFAX VA
22031-2359
US

V. Phone/Fax

Practice location:
  • Phone: 301-401-8704
  • Fax:
Mailing address:
  • Phone: 301-401-8704
  • Fax: 866-239-1494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC5625
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: