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General NPI Number Information
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NPI Number | 1003334210
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Entity Type | Organization
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Legal Business Name | ZION RESTORATION COUNSELING SERVICES
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Dates
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Enumeration Date | 09/07/2017
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Last Update Date | 09/07/2017
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Provider Practice Location Address
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Address Line | 5999 STEVENSON AVE
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City | ALEXANDRIA
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State | VA
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Zip | 22304-3304
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Country | US
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Telephone | 571-989-2729
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Fax | 571-989-2729
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Provider Business Mailing Address
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Address Line | 15915 CANADA GOOSE LOOP
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City | WOODBRIDGE
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State | VA
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Zip | 22191-5562
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Country | US
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Telephone | 12022557490
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | CARMEN J. RILEY
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Credential | LPC
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Telephone | 571-989-2729
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1701006505
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License Number State | VA
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