MEDICARE: SUNSTONE COUNSELING, PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	101YP2500X	Professional Counselor
3	106H00000X	Marriage & Family Therapist
4	261QM0855X	Adolescent and Children Mental Health Clinic/Center
5	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1740749258
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNSTONE COUNSELING, PLLC

Provider Business Mailing Address
First Line	:	124 E BROAD ST STE D
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22046-4530
Country	:	US
Telephone Number	:	703-328-4112
Fax Number	:

Provider Business Practice Location Address
First Line	:	124 E BROAD ST
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22046-4529
Country	:	US
Telephone Number	:	703-328-4112
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER
Name	:	MR. GEORGE KERMIT COYNE III
Credential	:	LCSW
Telephone Number	:	703-328-4112

Provider Enumeration Date	:	03/14/2019
Last Update Date	:	07/19/2022

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