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General NPI Number Information
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NPI Number | 1124587613
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Entity Type | Organization
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Legal Business Name | INSPIRED COURAGE COUNSELING AND CONSULTATION
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Dates
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Enumeration Date | 03/14/2019
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Last Update Date | 03/14/2019
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Provider Practice Location Address
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Address Line | 10560 MAIN ST UNIT 120
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City | FAIRFAX
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State | VA
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Zip | 22030-7182
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Country | US
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Telephone | 571-732-1122
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Fax |
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Provider Business Mailing Address
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Address Line | 4094 MAJESTIC LN UNIT 315
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City | FAIRFAX
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State | VA
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Zip | 22033-2104
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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 | CEO
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Name | DR. ALEXIS MELVILLE
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Credential | PSY.D
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Telephone | 571-732-1122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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