Healthcare Provider Details

I. General information

NPI: 1073247177
Provider Name (Legal Business Name): HYE JOON PAK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2022
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 HUNTER PL STE 101
WOODBRIDGE VA
22192-3938
US

IV. Provider business mailing address

2510 HUNTER PL STE 101
WOODBRIDGE VA
22192-3938
US

V. Phone/Fax

Practice location:
  • Phone: 571-596-4152
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: