Healthcare Provider Details

I. General information

NPI: 1376213579
Provider Name (Legal Business Name): NAOMI FATIMA OTHMAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2021
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 HOPE RD
STAFFORD VA
22554-7202
US

IV. Provider business mailing address

600 JACKSON ST
FREDERICKSBURG VA
22401-5719
US

V. Phone/Fax

Practice location:
  • Phone: 540-659-2725
  • Fax: 540-659-0736
Mailing address:
  • Phone: 540-373-3223
  • Fax: 540-371-3753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701016720
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: