Provider Demographics
NPI:1528694197
Name:BUCHANAN, STEPHANIE RENEE (LPC, NCC, QMHP-A)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:RENEE
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:LPC, NCC, QMHP-A
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:RENEE
Other - Last Name:WILLETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NCC, QMHP-A
Mailing Address - Street 1:3924 TEDRICH BLVD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-3543
Mailing Address - Country:US
Mailing Address - Phone:301-785-4153
Mailing Address - Fax:
Practice Address - Street 1:8221 WILLOW OAKS CORPORATE DR STE 3-330K
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4512
Practice Address - Country:US
Practice Address - Phone:301-785-4153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008992101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health