Healthcare Provider Details

I. General information

NPI: 1043063951
Provider Name (Legal Business Name): EARLY CHILDHOOD PARTNERS IN PRACTICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2024
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19420 GOLF VISTA PLZ STE 246
LANSDOWNE VA
20176-8276
US

IV. Provider business mailing address

19420 GOLF VISTA PLZ STE 246
LANSDOWNE VA
20176-8276
US

V. Phone/Fax

Practice location:
  • Phone: 703-936-1968
  • Fax:
Mailing address:
  • Phone: 703-936-1968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER L LOPEZ
Title or Position: OWNER, CLINICAL DIRECTOR
Credential: LCSW, RPT-S
Phone: 540-538-5368