Provider Demographics
NPI:1801555024
Name:IDEA COUNSELING SERVICES INC.
Entity type:Organization
Organization Name:IDEA COUNSELING SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:SHANE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:703-209-7624
Mailing Address - Street 1:9520 BLACKBURN DR
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-1713
Mailing Address - Country:US
Mailing Address - Phone:703-209-7624
Mailing Address - Fax:202-261-3508
Practice Address - Street 1:1250 CONNECTICUT AVE NW FL 7
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-2603
Practice Address - Country:US
Practice Address - Phone:703-209-7624
Practice Address - Fax:202-361-3508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty