Healthcare Provider Details

I. General information

NPI: 1538084116
Provider Name (Legal Business Name): KATHERINE FRAZE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 N KING ST STE 210
LEESBURG VA
20176-2846
US

IV. Provider business mailing address

303 FOXRIDGE DR SW
LEESBURG VA
20175-2511
US

V. Phone/Fax

Practice location:
  • Phone: 571-339-9869
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0704019298
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: