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General NPI Number Information
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NPI Number | 1568904373
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Entity Type | Individual
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Provider Name | ELEANOR VINCENT EDD, LPC, CSAC
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Gender | Female
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Dates
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Enumeration Date | 11/09/2016
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Last Update Date | 01/22/2017
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Provider Practice Location Address
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Address Line | 10560 MAIN ST SUITE 405
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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 | 703-474-6427
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Fax |
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Provider Business Mailing Address
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Address Line | 11350 RANDOM HILLS RD 8TH FLOOR
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City | FAIRFAX
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State | VA
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Zip | 22030-6044
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Country | US
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Telephone | 703-934-6006
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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 | 0710102639
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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 | 0701006683
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License Number State | VA
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