Healthcare Provider Details

I. General information

NPI: 1326839846
Provider Name (Legal Business Name): KOTA HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16045 HAMILTON STATION RD
WATERFORD VA
20197-1104
US

IV. Provider business mailing address

16045 HAMILTON STATION RD
WATERFORD VA
20197-1104
US

V. Phone/Fax

Practice location:
  • Phone: 703-727-2505
  • Fax:
Mailing address:
  • Phone: 703-727-2505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE CHRISTENSEN
Title or Position: OWNER
Credential: LMFT
Phone: 703-727-2505