Healthcare Provider Details

I. General information

NPI: 1275238289
Provider Name (Legal Business Name): BANSRI S PATEL LPC-R
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2023
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 LIBERTY ST SW
LEESBURG VA
20175-2715
US

IV. Provider business mailing address

42656 COCHRANS LOCK DR
ASHBURN VA
20148-4102
US

V. Phone/Fax

Practice location:
  • Phone: 804-207-6737
  • Fax:
Mailing address:
  • Phone: 860-405-4604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0704016203
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: