Healthcare Provider Details

I. General information

NPI: 1205052669
Provider Name (Legal Business Name): LISA A ZAGER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 FAIRFAX DR STE 62
ARLINGTON VA
22203-1762
US

IV. Provider business mailing address

5902 MOUNT EAGLE DR APT 105
ALEXANDRIA VA
22303-2514
US

V. Phone/Fax

Practice location:
  • Phone: 703-868-6835
  • Fax: 703-248-1998
Mailing address:
  • Phone: 703-868-6835
  • Fax: 703-248-1998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701003745
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: