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Organization
OCCOQUAN COUNSELING, LLC
Active
Organization
OCCOQUAN COUNSELING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY FACCIOLA LCSW (MEMBER/MANAGER)
(703) 203-7535
Entity
Organization
Contact information
Practice address
12866 HARBOR DR, WOODBRIDGE, VA 22192-2921
(703) 494-4164
(703) 563-9304
Mailing address
12866 HARBOR DR, WOODBRIDGE, VA 22192-2921
(703) 203-7535
(703) 563-9304
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904005064
VA
Other
Enumeration date
09/24/2008
Last updated
04/27/2018
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