Healthcare Provider Details

I. General information

NPI: 1689448540
Provider Name (Legal Business Name): ELITE STAR THERAPEUTIC SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2023
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4421 DIXIE HILL RD APT 409
FAIRFAX VA
22030-9080
US

IV. Provider business mailing address

4421 DIXIE HILL RD APT 409
FAIRFAX VA
22030-9080
US

V. Phone/Fax

Practice location:
  • Phone: 703-231-7727
  • Fax:
Mailing address:
  • Phone: 703-231-7727
  • 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 Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. RAMLA A ADEN
Title or Position: CEO
Credential:
Phone: 703-231-7727