Healthcare Provider Details

I. General information

NPI: 1104496512
Provider Name (Legal Business Name): VICTORIA PENNANT LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7960 DONEGAN DR STE 200
MANASSAS VA
20109-8236
US

IV. Provider business mailing address

780 LYNNHAVEN PKWY STE 340
VIRGINIA BEACH VA
23452-7361
US

V. Phone/Fax

Practice location:
  • Phone: 833-587-8825
  • Fax: 757-970-0274
Mailing address:
  • Phone: 757-694-4723
  • Fax: 757-301-8803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701010608
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: