MEDICARE: TAQWA ABDALLAH LPC

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	0701013414	VA

General Provider Information

NPI Number	:	1215789458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAQWA ABDALLAH LPC

Provider Business Mailing Address
First Line	:	2142 RICHMOND HWY STE 103-1035
Second Line	:
City	:	STAFFORD
State	:	VA
Zip	:	22554-7200
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2142 RICHMOND HWY STE 103-1035
Second Line	:
City	:	STAFFORD
State	:	VA
Zip	:	22554-7200
Country	:	US
Telephone Number	:	571-572-2018
Fax Number	:

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

Provider Enumeration Date	:	04/02/2024
Last Update Date	:	04/02/2024

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Directions to “ TAQWA ABDALLAH LPC” Practice Location

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