Healthcare Provider Details

I. General information

NPI: 1750858494
Provider Name (Legal Business Name): SABRINA ANDERSON MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2018
Last Update Date: 10/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7230 HERITAGE VILLAGE PLZ STE 202
GAINESVILLE VA
20155-3054
US

IV. Provider business mailing address

6320 FIELD FLOWER TRL
CENTREVILLE VA
20121-5623
US

V. Phone/Fax

Practice location:
  • Phone: 703-754-0636
  • Fax:
Mailing address:
  • Phone: 703-343-0139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701007128
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: