Organization
LIFELINE PSYCHOTHERAPY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HOANG OANH RODGERS LMFT, LPC (OWNER)
(703) 409-6258
Entity
Organization
Contact information
Practice address
11350 RANDOM HILLS RD STE 800, FAIRFAX, VA 22030-6044
(703) 409-6258
Mailing address
12646 HERON RIDGE DR, FAIRFAX, VA 22030-6638
(703) 409-6258
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
0710000893
VA
101YP2500X
Professional Counselor
0701002418
VA
106H00000X
Marriage & Family Therapist
Primary
0717000800
VA
Other
Enumeration date
10/24/2017
Last updated
10/24/2017
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