Healthcare Provider Details

I. General information

NPI: 1912816075
Provider Name (Legal Business Name): AMBER BEN-HANANIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1934 OLD GALLOWS RD STE 360
VIENNA VA
22182-4040
US

IV. Provider business mailing address

1934 OLD GALLOWS RD STE 360
VIENNA VA
22182-4040
US

V. Phone/Fax

Practice location:
  • Phone: 703-752-6181
  • Fax:
Mailing address:
  • Phone: 703-752-6181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0704019478
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number25923
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: