PHYLLIS M FORTUNATO MARTIN (NPI# 1215360532) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215360532 |
| Entity Type | Individual |
| Full Name | PHYLLIS M FORTUNATO MARTIN |
| Credential | LPC |
| Practice Address |
10400 Eaton Pl Suite 110 Fairfax VA 22030-2208 |
| Practice Telephone | 7035097412 |
| Mailing Telephone | 7035097412 |
| Enumeration Date | 2013-08-11 |
| Last Update Date | 2013-08-11 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YP2500X |
Counselor Specialization: Professional |
0701003077 | VA | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346716867 | Phyllis Ann Martin | Case Manager/Care Coordinator | 201 W Springdale Ave, Knoxville, TN 37917-5158 | 2018-10-23 |
| 1275967028 | Phyllis Jean Martin | Counselor | 647 34th Ave S, Saint Petersburg, FL 33705-3730 | 2013-08-29 |
| 1588742753 | Phyllis Martin | Psychologist | 1301 Summit St, Marshalltown, IA 50158-5484 | 2006-11-02 |
| Street Address |
10400 EATON PL SUITE 110 |
| City | FAIRFAX |
| State | VA |
| Zip Code | 22030-2208 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013047083 | Irene Carol Ilachinski | Social Worker | 10400 Eaton Pl, Ste 200, Fairfax, VA 22030-2208 | 2007-03-07 |
| 1609211036 | Fitness and Rehabilitation, Inc. | Clinic/Center | 10400 Eaton Pl, Suite 312, Fairfax, VA 22030-2208 | 2013-04-29 |
| 1023345881 | A Center for Adult, Family and Career Counseling | Community/Behavioral Health | 10400 Eaton Pl, Suite 110, Fairfax, VA 22030-2208 | 2009-11-14 |
| 1861519696 | Anita Diguglielmo Novak | Counselor | 10400 Eaton Pl, #110, Fairfax, VA 22030-2208 | 2007-03-25 |
| 1902923717 | Lisa D. Lyons | Counselor | 10400 Eaton Pl, Suite 110, Fairfax, VA 22030-2208 | 2007-03-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205449477 | Perry Camp Jr. | Psychologist | 4403 Dixie Hill Rd, Unit 205, Fairfax, VA 22030 | 2020-08-28 |
| 1952940322 | Brightview Fair Oaks, LLC | Alzheimer Center (Dementia Center) | 12725 Lee Highway, Fairfax, VA 22030 | 2020-01-02 |
| 1245871524 | Tori Sprowl | Behavioral Analyst | 10430 Democracy Lane #102b & 103, Fairfax, VA 22030 | 2019-10-08 |
| 1528612124 | Paul Sarigianis | Student in an Organized Health Care Education/Training Program | 10379b Democracy Lane, Fairfax, VA 22030 | 2019-07-31 |
| 1497221303 | Kahak, Inc. | Day Training, Developmentally Disabled Services | 10560 Main Street Suite Ps100, Fairfax, VA 22030 | 2018-10-17 |
| 1689177073 | Shamoona Sharif | Dentist | 11050 Lee Hwy, Fairfax, VA 22030 | 2018-03-13 |
| 1205339538 | Rachael Lee Greene | Social Worker | 4403 Dixie Hill Rd. #206, Fairfax, VA 22030 | 2018-03-13 |
| 1558863027 | Jacqueline Renee Bauer | Skilled Nursing Facility | 10701 Main Street, Fairfax, VA 22030 | 2018-03-01 |
| 1275033607 | Philajo Global LLC | Non-emergency Medical Transport (VAN) | 4521 Billingham Street, Fairfax, VA 22030 | 2018-02-12 |
| 1376050401 | Alexander Harrison | Counselor | 4400 University Drive, Ms 2a2, Fairfax, VA 22030 | 2018-01-10 |
| Find all providers in zip 22030 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629689401 | Ann Marie Miller | Counselor | 3600 Chain Bridge Rd Ste 200, Fairfax, VA 22030-3326 | 2020-08-13 |
| 1962046995 | Rebekah Stone | Counselor | 8221 Willow Oaks Corporate Dr Ste 430, Fairfax, VA 22031-4512 | 2019-11-02 |
| 1972153831 | Nichelle Arnette Staten | Counselor | 8221 Willow Oaks Corporate Dr # Ll-225, Fairfax, VA 22031-4512 | 2019-09-12 |
| 1710451505 | Chela Clark | Counselor | 8221 Willow Oaks Corporate Dr Ste 1, Fairfax, VA 22031-4512 | 2019-01-15 |
| 1386117026 | Andrea Nunes-gardner | Counselor | 10560 Main St Ph 4, Fairfax, VA 22030-7182 | 2019-01-04 |
| 1164990974 | Takhyun Cho | Counselor | 10560 Main St Ste 508, Fairfax, VA 22030-7173 | 2018-11-09 |
| 1457831364 | Tara Danielle Soligan | Counselor | 4023 Chain Bridge Rd Ste 7, Fairfax, VA 22030-4121 | 2018-08-20 |
| 1043718091 | Tatyana V Cottle | Counselor | 3509 Queen Anne Dr, Fairfax, VA 22030-1830 | 2018-01-24 |
| 1376050401 | Alexander Harrison | Counselor | 4400 University Drive, Ms 2a2, Fairfax, VA 22030 | 2018-01-10 |
| 1396250882 | Megan B Miller | Counselor | 8221 Willow Oaks Corporate Dr Ste 2east, Fairfax, VA 22031-4512 | 2017-12-06 |
| Find all providers in FAIRFAX | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.