Provider Demographics
NPI:1356957864
Name:CONNECT TO CARE COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:CONNECT TO CARE COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEITRA
Authorized Official - Middle Name:LATRICE
Authorized Official - Last Name:FANT
Authorized Official - Suffix:
Authorized Official - Credentials:MA,NCC,LCPC,LPC
Authorized Official - Phone:703-857-5354
Mailing Address - Street 1:118 N SAINT ASAPH ST STE G
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-3110
Mailing Address - Country:US
Mailing Address - Phone:703-857-5354
Mailing Address - Fax:571-601-4607
Practice Address - Street 1:118 N SAINT ASAPH ST STE G
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-3110
Practice Address - Country:US
Practice Address - Phone:703-857-5354
Practice Address - Fax:571-601-4607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-21
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD207319600Medicaid