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General NPI Number Information
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NPI Number | 1841606647
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Entity Type | Individual
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Provider Name | ELIZABETH JOY RZENGOTA MA, LPC
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Gender | Female
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Dates
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Enumeration Date | 07/01/2014
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Last Update Date | 09/22/2018
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Provider Practice Location Address
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Address Line | 10301 DEMOCRACY LN STE 275
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City | FAIRFAX
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State | VA
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Zip | 22030
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Country | US
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Telephone | 845-321-0430
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Fax |
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Provider Business Mailing Address
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Address Line | 10301 DEMOCRACY LN STE 275
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City | FAIRFAX
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State | VA
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Zip | 22030-2525
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Country | US
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Telephone | 703-397-3124
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Fax | 703-539-0004
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701007802
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License Number State | VA
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