Healthcare Provider Details

I. General information

NPI: 1902613516
Provider Name (Legal Business Name): KATHLEEN HABIG CSAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2024
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20500 WARRIORS WAY
MILFORD VA
22514-2867
US

IV. Provider business mailing address

57 EVERGLADES LN
STAFFORD VA
22554-7762
US

V. Phone/Fax

Practice location:
  • Phone: 804-529-3486
  • Fax:
Mailing address:
  • Phone: 703-870-4098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0710103880
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: