Provider Demographics
NPI:1306715362
Name:FANOUS KAMEL, IRENE
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:FANOUS KAMEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11166 FAIRFAX BLVD STE 207
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-5017
Mailing Address - Country:US
Mailing Address - Phone:571-279-0319
Mailing Address - Fax:
Practice Address - Street 1:11166 FAIRFAX BLVD STE 207
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-5017
Practice Address - Country:US
Practice Address - Phone:703-397-8163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-30
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health