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Organization
LIFESPAN COUNSELING SERVICES, LLC
Active
Organization
LIFESPAN COUNSELING SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DANIELLE C NICHOLSON LCSW (SOCIAL WORKER)
(703) 490-9681
Entity
Organization
Contact information
Practice address
8500 EXECUTIVE PARK AVE STE 204, FAIRFAX, VA 22031-2253
(703) 876-8480
Mailing address
5104 COLERIDGE DR, FAIRFAX, VA 22032-2420
(703) 965-8712
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904006801
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12093630
CAQH
VA
Enumeration date
05/03/2010
Last updated
04/29/2015
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