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General NPI Number Information
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NPI Number | 1356957864
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Entity Type | Organization
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Legal Business Name | CONNECT TO CARE COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 09/21/2020
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Last Update Date | 01/24/2025
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Provider Practice Location Address
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Address Line | 118 N SAINT ASAPH ST STE G
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City | ALEXANDRIA
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State | VA
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Zip | 22314-3110
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Country | US
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Telephone | 703-857-5354
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Fax | 571-601-4607
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Provider Business Mailing Address
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Address Line | 118 N SAINT ASAPH ST STE G
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City | ALEXANDRIA
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State | VA
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Zip | 22314-3110
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Country | US
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Telephone | 703-857-5354
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Fax | 571-601-4607
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Authorized Official
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Title or Position | OWNER/CLINICIAN
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Name | MRS. DEITRA LATRICE FANT
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Credential | MA,NCC,LCPC,LPC
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Telephone | 703-857-5354
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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