Provider Demographics
NPI:1376161513
Name:WAVES OF COURAGE COUNSELING LLC
Entity Type:Organization
Organization Name:WAVES OF COURAGE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:THERESA
Authorized Official - Last Name:GETHA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:571-206-8383
Mailing Address - Street 1:9480 MAIN ST # 1060
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4032
Mailing Address - Country:US
Mailing Address - Phone:571-206-8383
Mailing Address - Fax:
Practice Address - Street 1:13132 MELVILLE LN
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-3701
Practice Address - Country:US
Practice Address - Phone:877-928-3704
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-13
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health