Provider Demographics
NPI:1922603158
Name:CONCEPCION, ESTEFANIA (LPC)
Entity Type:Individual
Prefix:
First Name:ESTEFANIA
Middle Name:
Last Name:CONCEPCION
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14150 PARKEAST CIR STE 200
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-4212
Mailing Address - Country:US
Mailing Address - Phone:703-449-6114
Mailing Address - Fax:
Practice Address - Street 1:14150 PARKEAST CIR STE 200
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-4212
Practice Address - Country:US
Practice Address - Phone:703-449-6114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-04
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701009718101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty