=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114464526
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMBRACE LIFE COMPREHENSIVE AND INTEGRATIVE COUNSELING SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2017
-----------------------------------------------------
Last Update Date | 05/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 238 TOLUCA RD
-----------------------------------------------------
City | STAFFORD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22556-1852
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-515-7884
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 238 TOLUCA RD
-----------------------------------------------------
City | STAFFORD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22556-1852
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-515-7884
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. TRACY CHRISTINE PERL
-----------------------------------------------------
Credential | LPC, NCC, BCPCC
-----------------------------------------------------
Telephone | 917-515-7884
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 0701005883
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------