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General NPI Number Information
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NPI Number | 1982105573
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Entity Type | Organization
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Legal Business Name | LIFE HOPE COUNSELING CENTER LLC
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Dates
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Enumeration Date | 02/28/2018
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Last Update Date | 06/30/2022
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Provider Practice Location Address
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Address Line | 44679 ENDICOTT DR STE 412
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City | ASHBURN
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State | VA
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Zip | 20147-5567
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Country | US
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Telephone | 703-957-8761
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Fax | 703-270-0525
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Provider Business Mailing Address
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Address Line | 44679 ENDICOTT DR STE 412
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City | ASHBURN
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State | VA
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Zip | 20147-5567
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Country | US
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Telephone | 703-957-8761
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Fax | 703-270-0525
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | TISA MCKENNA PINKERTON
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Credential | LCSW
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Telephone | 703-957-8761
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 0904009000
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License Number State | VA
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