Healthcare Provider Details

I. General information

NPI: 1902722549
Provider Name (Legal Business Name): VICTORIA MORILLO QMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2026
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6563 EDSALL RD
SPRINGFIELD VA
22151-4414
US

IV. Provider business mailing address

43101 EDGEWATER ST
SOUTH RIDING VA
20152-3401
US

V. Phone/Fax

Practice location:
  • Phone: 703-354-0000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0733009060
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: