Healthcare Provider Details

I. General information

NPI: 1699776021
Provider Name (Legal Business Name): LYNN FERTELL FIELD PHD, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 11/27/2023
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10721 MAIN ST SUITE 2350
FAIRFAX VA
22030-6914
US

IV. Provider business mailing address

10721 MAIN ST SUITE 2350
FAIRFAX VA
22030-6914
US

V. Phone/Fax

Practice location:
  • Phone: 703-591-5912
  • Fax: 703-591-7210
Mailing address:
  • Phone: 703-591-5912
  • Fax: 703-591-7210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701002865
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: