Healthcare Provider Details

I. General information

NPI: 1316825631
Provider Name (Legal Business Name): ELYSE MARIA ECHEGARAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8206 LEESBURG PIKE STE 302
VIENNA VA
22182-2614
US

IV. Provider business mailing address

8206 LEESBURG PIKE STE 302
VIENNA VA
22182-2614
US

V. Phone/Fax

Practice location:
  • Phone: 703-594-1535
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0704019249
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: