Provider Demographics
NPI:1992287114
Name:SKOGSBERG, ELLEN (LPC)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:SKOGSBERG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21050 LOWRY PARK TER APT 203
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-6431
Mailing Address - Country:US
Mailing Address - Phone:540-449-1490
Mailing Address - Fax:
Practice Address - Street 1:21155 WHITFIELD PL STE 202
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-7277
Practice Address - Country:US
Practice Address - Phone:571-375-0668
Practice Address - Fax:703-687-3622
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-04
Last Update Date:2023-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007834101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional