Healthcare Provider Details

I. General information

NPI: 1699250365
Provider Name (Legal Business Name): PABLO DAVID RODRIGUEZ MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2018
Last Update Date: 10/04/2021
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 HERITAGE WAY NE STE 302
LEESBURG VA
20176-4544
US

IV. Provider business mailing address

102 HERITAGE WAY NE STE 302
LEESBURG VA
20176-4544
US

V. Phone/Fax

Practice location:
  • Phone: 703-771-5100
  • Fax: 703-777-0170
Mailing address:
  • Phone: 703-771-5100
  • Fax: 703-777-0170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904013308
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: