Healthcare Provider Details

I. General information

NPI: 1902267305
Provider Name (Legal Business Name): METANOIA CHILD AND FAMILY COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2016
Last Update Date: 03/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10837 MONTICELLO DR
GREAT FALLS VA
22066-4225
US

IV. Provider business mailing address

10837 MONTICELLO DR
GREAT FALLS VA
22066-4225
US

V. Phone/Fax

Practice location:
  • Phone: 703-901-9721
  • Fax:
Mailing address:
  • Phone: 703-901-9721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. LAURIE LEIGH HESLER
Title or Position: MARRIAGE AND FAMILY THERAPIST
Credential: LMFT, ATR-BC, ATCS
Phone: 703-901-9721