MEDICARE: PINKLEAF RELATIONSHIP & MENTAL HEALTH WELLNESS LLC

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

General Provider Information

NPI Number	:	1588529119
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINKLEAF RELATIONSHIP & MENTAL HEALTH WELLNESS LLC

Provider Business Mailing Address
First Line	:	3060 WILLIAMS DR STE 3001005
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22031-4667
Country	:	US
Telephone Number	:	571-540-9258
Fax Number	:	703-936-8319

Provider Business Practice Location Address
First Line	:	3060 WILLIAMS DR STE 3001005
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22031-4667
Country	:	US
Telephone Number	:	571-540-9258
Fax Number	:	703-936-8319

Authorized Official
Title or Position	:	OWNER/CLINICIAN
Name	:	ELIZABETH GREENE
Credential	:	LPC
Telephone Number	:	540-840-1593

Provider Enumeration Date	:	12/16/2025
Last Update Date	:	12/16/2025

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