Provider Demographics
NPI:1134732969
Name:VINNIKOV, STEPHANIE (BA)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:
Last Name:VINNIKOV
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5840 CAMERON RUN TER APT 804
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22303-1853
Mailing Address - Country:US
Mailing Address - Phone:732-668-5064
Mailing Address - Fax:
Practice Address - Street 1:107 CARPENTER DR STE 210
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20164-4468
Practice Address - Country:US
Practice Address - Phone:703-297-4368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor