Provider Demographics
NPI:1992267454
Name:LUMINESCENCE COUNSELING LLC
Entity type:Organization
Organization Name:LUMINESCENCE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FAIZA
Authorized Official - Middle Name:OMER
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:713-933-8903
Mailing Address - Street 1:7644 AUDUBON MEADOW WAY
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-2277
Mailing Address - Country:US
Mailing Address - Phone:713-933-8903
Mailing Address - Fax:
Practice Address - Street 1:300 N WASHINGTON ST STE 607
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2544
Practice Address - Country:US
Practice Address - Phone:713-933-8903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty