MEDICARE: OCCOQUAN COUNSELING, 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	1041C0700X	Clinical Social Worker	0904005064	VA

General Provider Information

NPI Number	:	1780834911
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCCOQUAN COUNSELING, LLC

Provider Business Mailing Address
First Line	:	12866 HARBOR DR
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22192-2921
Country	:	US
Telephone Number	:	703-203-7535
Fax Number	:	703-563-9304

Provider Business Practice Location Address
First Line	:	12866 HARBOR DR
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22192-2921
Country	:	US
Telephone Number	:	703-494-4164
Fax Number	:	703-563-9304

Authorized Official
Title or Position	:	MEMBER/MANAGER
Name	:	KELLY FACCIOLA
Credential	:	LCSW
Telephone Number	:	703-203-7535

Provider Enumeration Date	:	09/24/2008
Last Update Date	:	04/27/2018

Similar Medicare Providers

1962494351 — MRS. LINDA P JOHNSON LCSW
Practice Location Address:

12890 HARBOR DR
WOODBRIDGE, VA
22192-2921

Practice Phone: 703-541-1606
Practice Fax:

1598873101 — KELLY FACCIOLA LCSW
Practice Location Address:

12866 HARBOR DR
WOODBRIDGE, VA
22192-2921

Practice Phone: 703-494-4164
Practice Fax: 703-563-9304

1578619763 — DR. LAWRENCE E. SUTTON L.P.C.
Practice Location Address:

12890 HARBOR DR
WOODBRIDGE, VA
22192-2921

Practice Phone: 703-490-3497
Practice Fax: 703-491-7662

1790903755 — MRS. MARY ELIZABETH (BETS) BYRNE L.C.S.W.
Practice Location Address:

12866 HARBOR DR
WOODBRIDGE, VA
22192-2921

Practice Phone: 703-490-3346
Practice Fax:

1215128665 — LINDA P. JOHNSON
Practice Location Address:

12890 HARBOR DR
WOODBRIDGE, VA
22192-2921

Practice Phone: 706-541-1606
Practice Fax: 703-670-9453

1720338627 — MR. NICHOLAS ANTONIO WILLIAMS NCC, LPC
Practice Location Address:

12890 HARBOR DR
WOODBRIDGE, VA
22192-2921

Practice Phone: 571-316-1020
Practice Fax:

Directions to “OCCOQUAN COUNSELING, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.