Individual
KEVIN ICHASO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9480 MAIN ST # 1197, FAIRFAX, VA 22031-4032
(703) 509-0618
Mailing address
9480 MAIN ST # 1197, FAIRFAX, VA 22031-4032
(703) 509-0618
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0701016056
VA
101YM0800X
Mental Health Counselor
Primary
0704014870
VA
Other
Enumeration date
03/12/2026
Last updated
04/04/2026
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