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General NPI Number Information
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NPI Number | 1053135053
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Entity Type | Organization
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Legal Business Name | AWARENESS LOUNGE COUNSELING, LLC
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Dates
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Enumeration Date | 11/14/2024
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 9553 BALLAGAN CT
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City | BRISTOW
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State | VA
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Zip | 20136-2700
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Country | US
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Telephone | 703-470-7081
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Fax |
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Provider Business Mailing Address
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Address Line | 9553 BALLAGAN CT
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City | BRISTOW
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State | VA
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Zip | 20136-2700
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Country | US
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Telephone | 703-470-7081
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | MRS. PATRICIA CISNERO
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Credential | MS, LPC
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Telephone | 703-470-7081
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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