Provider Demographics
NPI:1902924061
Name:NORTHERN VIRGINIA FAMILY SERVICE
Entity Type:Organization
Organization Name:NORTHERN VIRGINIA FAMILY SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:F
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:703-219-2128
Mailing Address - Street 1:10455 WHITE GRANITE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124-2764
Mailing Address - Country:US
Mailing Address - Phone:703-219-2128
Mailing Address - Fax:
Practice Address - Street 1:10455 WHITE GRANITE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:OAKTON
Practice Address - State:VA
Practice Address - Zip Code:22124-2764
Practice Address - Country:US
Practice Address - Phone:703-219-2128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09400532101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA622818OtherNATIONAL CAPITAL PPO
VA100071497001OtherAPS
VA246351OtherKAISER
VA7096491OtherAETNA
VA465746OtherANTHEM BCBS