Healthcare Provider Details

I. General information

NPI: 1619474640
Provider Name (Legal Business Name): BARBARA JEAN STEPHENSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2018
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9532 LIBERIA AVE STE 721
MANASSAS VA
20110-1719
US

IV. Provider business mailing address

9532 LIBERIA AVE STE 721
MANASSAS VA
20110-1719
US

V. Phone/Fax

Practice location:
  • Phone: 703-334-2206
  • Fax: 703-334-2206
Mailing address:
  • Phone: 703-334-2206
  • Fax: 703-334-2206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0717001483
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: