Healthcare Provider Details

I. General information

NPI: 1336946235
Provider Name (Legal Business Name): ELENI YIASEMIDES MFCT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2025
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 OLDE GREENWICH DR STE 210
FREDERICKSBURG VA
22408-4002
US

IV. Provider business mailing address

9452 MILL POND RD
SPOTSYLVANIA VA
22551-3534
US

V. Phone/Fax

Practice location:
  • Phone: 540-847-2876
  • Fax: 540-371-4333
Mailing address:
  • Phone: 540-760-4552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0730000610
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0704014168
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: