Provider Demographics
NPI:1902155161
Name:BALCAZAR, CAROLINA CELESTE (LPC)
Entity Type:Individual
Prefix:
First Name:CAROLINA
Middle Name:CELESTE
Last Name:BALCAZAR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CAROLINA
Other - Middle Name:CELESTE
Other - Last Name:FAGGIONI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:7611 LITTLE RIVER TPKE STE 200E
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-2640
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7611 LITTLE RIVER TPKE STE 200E
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-2640
Practice Address - Country:US
Practice Address - Phone:703-531-6285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-04
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005268101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1902155161OtherNPI