# LIFELINE PSYCHOTHERAPY SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417469974
- **Authorized official:** HOANG OANH RODGERS LMFT, LPC (OWNER)
- **Authorized official phone:** (703) 409-6258

## Contact information

- **Practice address:** 11350 RANDOM HILLS RD STE 800, FAIRFAX, VA 22030-6044
- **Practice address phone:** (703) 409-6258
- **Mailing address:** 12646 HERON RIDGE DR, FAIRFAX, VA 22030-6638
- **Mailing address phone:** (703) 409-6258

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | 0710000893 | VA | — |
| 101YP2500X | Professional Counselor | 0701002418 | VA | — |
| 106H00000X | Marriage & Family Therapist | 0717000800 | VA | Yes |

## Other

- **Enumeration date:** 10/24/2017
- **Last updated:** 10/24/2017