Healthcare Provider Details

I. General information

NPI: 1154157204
Provider Name (Legal Business Name): TINA E ADKINS PHD, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2024
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11260 ROGER BACON DR STE 204
RESTON VA
20190-5252
US

IV. Provider business mailing address

11260 ROGER BACON DR STE 204
RESTON VA
20190-5252
US

V. Phone/Fax

Practice location:
  • Phone: 703-544-9120
  • Fax:
Mailing address:
  • Phone: 703-544-9120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701013870
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number80452
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: