Basic Information
| Provider Information | |||||||||
| NPI: | 1275070435 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FRYE | ||||||||
| FirstName: | ANGELA | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21641 RIDGETOP CIR STE 210 | ||||||||
| Address2: | |||||||||
| City: | STERLING | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201666597 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037715100 | ||||||||
| FaxNumber: | 7037770170 | ||||||||
| Practice Location | |||||||||
| Address1: | 102 HERITAGE WAY NE STE 302 | ||||||||
| Address2: | |||||||||
| City: | LEESBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201764544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037715100 | ||||||||
| FaxNumber: | 7037770170 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2017 | ||||||||
| LastUpdateDate: | 11/19/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 101YP2500X | 0701007962 | VA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.