Healthcare Provider Details

I. General information

NPI: 1740708122
Provider Name (Legal Business Name): ELIZABETH FERNANDEZ LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2017
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 MICHAEL FARADAY DR STE 202
RESTON VA
20190-5348
US

IV. Provider business mailing address

1821 MICHAEL FARADAY DR STE 202
RESTON VA
20190-5348
US

V. Phone/Fax

Practice location:
  • Phone: 703-966-5173
  • Fax: 888-501-2627
Mailing address:
  • Phone: 703-966-5173
  • Fax: 888-501-2627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701013189
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: