MEDICARE: MIA MACKENZIE SEBASTIAN

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
2	101Y00000X	Counselor

General Provider Information

NPI Number	:	1568325553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIA MACKENZIE SEBASTIAN

Provider Business Mailing Address
First Line	:	22904 BENSON TER
Second Line	:
City	:	STERLING
State	:	VA
Zip	:	20166-4332
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12007 SUNRISE VALLEY DR
Second Line	:
City	:	RESTON
State	:	VA
Zip	:	20191-3479
Country	:	US
Telephone Number	:	703-522-2089
Fax Number	:

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

Provider Enumeration Date	:	12/05/2025
Last Update Date	:	12/05/2025

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Directions to “ MIA MACKENZIE SEBASTIAN ” Practice Location

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