Provider Demographics
NPI:1124320205
Name:DAILEY, STEPHANIE FARISS (MA, LPC, NCC, ACS)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:FARISS
Last Name:DAILEY
Suffix:
Gender:F
Credentials:MA, LPC, NCC, ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2512 N KENILWORTH STREET
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207-1419
Mailing Address - Country:US
Mailing Address - Phone:703-861-3383
Mailing Address - Fax:
Practice Address - Street 1:2512 N KENILWORTH STREET
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22207-1419
Practice Address - Country:US
Practice Address - Phone:703-861-3383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-23
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004660101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health