Individual
STEPHANIE FELLENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
2239F TACKETTS MILL DR, PSYCHOLOGICAL & LIFE SKILLS ASSOC PC, LAKE RIDGE, VA 22192
(703) 490-0336
(703) 490-4525
Mailing address
2239F TACKETTS MILL DR, PSYCHOLOGICAL & LIFE SKILLS ASSOC PC, LAKE RIDGE, VA 22192
(703) 490-0336
(703) 490-4525
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810003529
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
178511
ANTHEM BCBS
VA
01
—
23570022
CAREFIRST
VA
Enumeration date
10/10/2006
Last updated
07/08/2007
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