Provider Demographics
NPI:1497044150
Name:FAIRFAX COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:FAIRFAX COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:TO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:703-349-2999
Mailing Address - Street 1:10560 MAIN ST
Mailing Address - Street 2:SUITE 518
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-7182
Mailing Address - Country:US
Mailing Address - Phone:703-349-2999
Mailing Address - Fax:703-652-6030
Practice Address - Street 1:10560 MAIN ST
Practice Address - Street 2:SUITE 518
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-7182
Practice Address - Country:US
Practice Address - Phone:703-349-2999
Practice Address - Fax:703-652-6030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003637251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health