Healthcare Provider Details

I. General information

NPI: 1104781897
Provider Name (Legal Business Name): ACTIVV MANASSAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10605 GASKINS WAY
MANASSAS VA
20109-2371
US

IV. Provider business mailing address

10605 GASKINS WAY
MANASSAS VA
20109-2371
US

V. Phone/Fax

Practice location:
  • Phone: 703-966-5173
  • Fax:
Mailing address:
  • Phone:
  • 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: CHRISTOPHER LEIBOWITZ
Title or Position: GENERAL PARTNER
Credential: LCSW
Phone: 703-966-5173