Organization
AGAPE MENTAL HEALTH AND CONSULTING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. FAY MARSHALL PHILLIPS-LESANE MSW (OWNER/THERAPIST)
(703) 309-3031
Entity
Organization
Contact information
Practice address
3095 P. S. BUSINESS CENTER DRIVE, WOODBRIDGE, VA 22192
(703) 309-3031
Mailing address
PO BOX 4986, WOODBRIDGE, VA 22194-4986
(703) 309-3031
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904003313
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008939152
—
VA
01
—
110630
VALUE OPTIONS
VA
01
—
187248
ANTHEM BC/ BS
VA
01
—
301819
AMERIGROUP
VA
01
—
M283001
CAREFIRST
VA
Enumeration date
08/05/2006
Last updated
11/14/2016
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