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General NPI Number Information
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NPI Number | 1366251696
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Entity Type | Individual
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Provider Name | ANIS AFIGU SACCOH
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Gender | Male
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Dates
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Enumeration Date | 01/02/2025
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | PO BOX 151
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City | DUMFRIES
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State | VA
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Zip | 22026-0151
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Country | US
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Telephone | 571-774-5083
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Fax |
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Provider Business Mailing Address
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Address Line | 134 CONNERY TER SW
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City | LEESBURG
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State | VA
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Zip | 20175-5060
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Country | US
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Telephone | 571-274-3811
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0719000029
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0704016158
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License Number State | VA
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