Healthcare Provider Details

I. General information

NPI: 1992287114
Provider Name (Legal Business Name): ELLEN SKOGSBERG LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2018
Last Update Date: 10/15/2023
Certification Date: 10/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21155 WHITFIELD PL STE 202
STERLING VA
20165-7277
US

IV. Provider business mailing address

21050 LOWRY PARK TER APT 203
ASHBURN VA
20147-6431
US

V. Phone/Fax

Practice location:
  • Phone: 571-375-0668
  • Fax: 703-687-3622
Mailing address:
  • Phone: 540-449-1490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701007834
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: