Provider Demographics
NPI:1982105573
Name:LIFE HOPE COUNSELING CENTER LLC
Entity Type:Organization
Organization Name:LIFE HOPE COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TISA
Authorized Official - Middle Name:MCKENNA
Authorized Official - Last Name:PINKERTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:703-957-8761
Mailing Address - Street 1:44679 ENDICOTT DR STE 412
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5567
Mailing Address - Country:US
Mailing Address - Phone:703-957-8761
Mailing Address - Fax:703-270-0525
Practice Address - Street 1:44679 ENDICOTT DR STE 412
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5567
Practice Address - Country:US
Practice Address - Phone:703-957-8761
Practice Address - Fax:703-270-0525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-28
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904009000251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health