Healthcare Provider Details

I. General information

NPI: 1477337699
Provider Name (Legal Business Name): SASHA LEE ZIZZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 08/21/2023
Certification Date: 08/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 CLARENDON BLVD
ARLINGTON VA
22201-5447
US

IV. Provider business mailing address

711 N WAYNE ST APT 303
ARLINGTON VA
22201-1871
US

V. Phone/Fax

Practice location:
  • Phone: 703-228-1567
  • Fax:
Mailing address:
  • Phone: 907-406-8245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: