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General NPI Number Information
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NPI Number | 1841840170
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Entity Type | Individual
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Provider Name | KATRINA LYNETTE CLAY LPC
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Gender | Female
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Dates
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Enumeration Date | 09/18/2019
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Last Update Date | 09/18/2019
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Provider Practice Location Address
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Address Line | 8221 WILLOW OAKS CORPORATE DR
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City | FAIRFAX
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State | VA
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Zip | 22031-4512
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Country | US
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Telephone | 703-207-7895
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Fax | 703-653-6694
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Provider Business Mailing Address
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Address Line | 3113 FENNEGAN CT
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City | WOODBRIDGE
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State | VA
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Zip | 22192-1123
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Country | US
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Telephone | 703-867-5109
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701008609
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License Number State | VA
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