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General NPI Number Information
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NPI Number | 1619407673
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Entity Type | Individual
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Provider Name | ANDREY FADEYEV LCSW
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Gender | Male
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Dates
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Enumeration Date | 06/13/2017
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Last Update Date | 01/04/2019
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Provider Practice Location Address
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Address Line | 300 N WASHINGTON ST STE 607
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City | ALEXANDRIA
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State | VA
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Zip | 22314-2544
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Country | US
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Telephone | 202-656-3481
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Fax |
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Provider Business Mailing Address
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Address Line | 13300 DIGGES TER
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City | FORT WASHINGTON
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State | MD
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Zip | 20744-6544
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Country | US
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Telephone |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0904009834
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License Number State | VA
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