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General NPI Number Information
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NPI Number | 1114521226
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Entity Type | Individual
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Provider Name | SAMANTHA STEVENS LPC
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Gender | Female
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Dates
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Enumeration Date | 11/30/2020
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Last Update Date | 05/24/2021
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Provider Practice Location Address
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Address Line | 3258 GOLANSKY BOULEVARD SUITE 201
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City | WOODBRIDGE
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State | VA
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Zip | 22192-3253
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Country | US
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Telephone | 571-535-4706
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5396
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City | WOODBRIDGE
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State | VA
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Zip | 22194-5396
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 0701010045
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License Number State | VA
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