=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346250289
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COUNSELING AND FORENSIC SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2006
-----------------------------------------------------
Last Update Date | 06/30/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1308 DEVILS REACH RD SUITE 300
-----------------------------------------------------
City | WOODBRIDGE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22192-2806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-492-2994
-----------------------------------------------------
Fax | 703-490-5505
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1308 DEVILS REACH RD STE 300
-----------------------------------------------------
City | WOODBRIDGE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22192-2806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-492-2994
-----------------------------------------------------
Fax | 703-490-5505
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. STEPHANIE HARDENBURG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 703-492-2994
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 0701001846
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------