Healthcare Provider Details

I. General information

NPI: 1952819492
Provider Name (Legal Business Name): ALISSA WULFF LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2018
Last Update Date: 02/20/2024
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 EATON PL STE 420
FAIRFAX VA
22030-2208
US

IV. Provider business mailing address

12926 CEDAR GLEN LN
HERNDON VA
20171-2951
US

V. Phone/Fax

Practice location:
  • Phone: 703-261-4696
  • Fax:
Mailing address:
  • Phone: 703-261-4696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701007451
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: