Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Convergence Mental Performance and Preparation Lab

Organization Professional Counselor · NPI 1346015815

Convergence Mental Performance and Preparation Lab is a Professional Counselor in Fairfax, Virginia. Registered with an NPI since 2023.

In the registry since
2023
Specialties on file
3

Practice location Address checks out

4000 Legato Rd Ste 1100
Fairfax, VA 22033-2893
Phone: (571) 336-2272
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X
Professional Counselor Taxonomy 101YP2500X
Exercise & Sports Psychologist Taxonomy 103TE1100X

Record details

NPI number1346015815
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Tawana Butler — Owner/Ceo · (817) 913-5428
Other names Convergence Mental Performance Lab; Convergence Prep
NPI enumeratedNovember 15, 2023
Last updated in NPPESNovember 15, 2023
Certification dateNovember 15, 2023
Mailing address15000 Potomac Town Pl Ste 100-151, Woodbridge, VA 22191-6586

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