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General NPI Number Information
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NPI Number | 1659003622
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Entity Type | Individual
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Provider Name | DANIETTA CHARLES LPC
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Gender | Female
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Dates
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Enumeration Date | 06/28/2022
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Last Update Date | 06/28/2022
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Provider Practice Location Address
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Address Line | 9677 MAIN ST
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City | FAIRFAX
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State | VA
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Zip | 22031-3763
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Country | US
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Telephone | 301-767-1733
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Fax |
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Provider Business Mailing Address
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Address Line | 8209 PERIDOT DR UNIT 306
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City | TYSONS CORNER
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State | VA
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Zip | 22102-3968
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Country | US
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Telephone | 315-399-6318
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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 | 0701011580
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License Number State | VA
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