Provider Demographics
NPI:1558542928
Name:STELLA BRIZUELA-MORENO DBA INTERNATIONAL CONSULTING CENTER
Entity Type:Organization
Organization Name:STELLA BRIZUELA-MORENO DBA INTERNATIONAL CONSULTING CENTER
Other - Org Name:INTERNATIONAL CONSULTING CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIZUELA-MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:703-255-1600
Mailing Address - Street 1:8300 BOONE BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2626
Mailing Address - Country:US
Mailing Address - Phone:703-255-1600
Mailing Address - Fax:703-652-7641
Practice Address - Street 1:8300 BOONE BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-2626
Practice Address - Country:US
Practice Address - Phone:703-255-1600
Practice Address - Fax:703-652-7641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0718000189103TA0400X
DCPRC 312103TC1900X
VA0717000665106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty