MEDICARE: MRS. STEPHANIE FARISS DAILEY M.A., LPC, NCC, ACS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	0701004660	VA

General Provider Information

NPI Number	:	1124320205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHANIE FARISS DAILEY M.A., LPC, NCC, ACS

Provider Business Mailing Address
First Line	:	2512 N KENILWORTH STREET
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22207-1419
Country	:	US
Telephone Number	:	703-861-3383
Fax Number	:

Provider Business Practice Location Address
First Line	:	2512 N KENILWORTH STREET
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22207-1419
Country	:	US
Telephone Number	:	703-861-3383
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2010
Last Update Date	:	11/23/2010

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