Healthcare Provider Details

I. General information

NPI: 1558295964
Provider Name (Legal Business Name): MERON ABEBE LOUISSAINT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4410 BROOKFIELD CORPORATE DR UNIT 222891
CHANTILLY VA
20153-8099
US

IV. Provider business mailing address

4410 BROOKFIELD CORPORATE DR UNIT 222891
CHANTILLY VA
20153-8099
US

V. Phone/Fax

Practice location:
  • Phone: 571-409-4735
  • Fax:
Mailing address:
  • Phone: 571-409-4735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904012549
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: