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General NPI Number Information
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NPI Number | 1346614690
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE COUNSELING SOLUTIONS, LLC
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Dates
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Enumeration Date | 11/24/2015
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Last Update Date | 11/24/2015
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Provider Practice Location Address
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Address Line | 4229 LAFAYETTE CENTER DR STE 1200
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City | CHANTILLY
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State | VA
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Zip | 20151-1265
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Country | US
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Telephone | 703-470-1202
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Fax |
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Provider Business Mailing Address
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Address Line | 42161 BLACK HILLS PL
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City | STONE RIDGE
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State | VA
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Zip | 20105-2932
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Country | US
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Telephone | 703-470-1202
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANA KARINA PORTO
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Credential |
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Telephone | 703-470-1202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 0701006220
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License Number State | VA
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