Healthcare Provider Details

I. General information

NPI: 1124725973
Provider Name (Legal Business Name): MMERE DANE COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2023
Last Update Date: 02/13/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14952 FIG CT
WOODBRIDGE VA
22193-6025
US

IV. Provider business mailing address

4222 FORTUNA CENTER PLZ STE 122
MONTCLAIR VA
22025-1515
US

V. Phone/Fax

Practice location:
  • Phone: 912-980-5489
  • Fax:
Mailing address:
  • Phone: 703-261-9528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. SABRINA SHANTE ADKINSON
Title or Position: CLINICAL DIRECTOR
Credential: LPC
Phone: 703-261-9528