Healthcare Provider Details

I. General information

NPI: 1679041164
Provider Name (Legal Business Name): ELIZABETH NEIL LPC, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2018
Last Update Date: 11/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 DOLLEY MADISON BLVD
MC LEAN VA
22101-3019
US

IV. Provider business mailing address

4094 MAJESTIC LN # 237
FAIRFAX VA
22033-2104
US

V. Phone/Fax

Practice location:
  • Phone: 703-335-6172
  • Fax:
Mailing address:
  • Phone: 703-335-6172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number070100848
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number071700137
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: