MEDICARE: NOVA THERAPY LOUNGE, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor
3	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1306673611
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVA THERAPY LOUNGE, LLC

Provider Business Mailing Address
First Line	:	14451 N SLOPE ST
Second Line	:
City	:	CENTREVILLE
State	:	VA
Zip	:	20120-4151
Country	:	US
Telephone Number	:	571-409-1783
Fax Number	:

Provider Business Practice Location Address
First Line	:	14451 N SLOPE ST
Second Line	:
City	:	CENTREVILLE
State	:	VA
Zip	:	20120-4151
Country	:	US
Telephone Number	:	571-409-1783
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PROFESSIONAL COUNSELOR
Name	:	MARJOLIJN NARSIS HIEMSTRA
Credential	:	LPC, NLP
Telephone Number	:	571-409-1783

Provider Enumeration Date	:	09/19/2024
Last Update Date	:	02/15/2026

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