Provider Demographics
NPI:1912404757
Name:CONVERSATIONS FAIRFAX COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:CONVERSATIONS FAIRFAX COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:BURKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:703-483-1520
Mailing Address - Street 1:9900 MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-3907
Mailing Address - Country:US
Mailing Address - Phone:703-483-1520
Mailing Address - Fax:
Practice Address - Street 1:9900 MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-3907
Practice Address - Country:US
Practice Address - Phone:703-483-1520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717001265101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty