Provider Demographics
NPI:1811679038
Name:DIVERSE EXPRESSIONS COUNSELING LLC
Entity type:Organization
Organization Name:DIVERSE EXPRESSIONS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:BILE
Authorized Official - Last Name:OULATTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-565-9484
Mailing Address - Street 1:8721 PLANTATION LN STE 302
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-8324
Mailing Address - Country:US
Mailing Address - Phone:571-307-2324
Mailing Address - Fax:571-569-4480
Practice Address - Street 1:8721 PLANTATION LN STE 302
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-8324
Practice Address - Country:US
Practice Address - Phone:571-307-2324
Practice Address - Fax:571-569-4480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-07
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty