Organization
CONSTELLATION COUNSELING SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CORTLANDT H MAZZOTTA (OWNER)
(301) 304-8825
Entity
Organization
Contact information
Practice address
4129 DALLAS HUTCHISON ST, CHANTILLY, VA 20151-2944
(301) 304-8825
Mailing address
4129 DALLAS HUTCHISON ST, CHANTILLY, VA 20151-2944
(301) 304-8825
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1285193730
OPTUM
TN
Enumeration date
08/22/2024
Last updated
08/22/2024
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