Healthcare Provider Details

I. General information

NPI: 1467367771
Provider Name (Legal Business Name): AYA ADEL ELTAHIR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8614 WESTWOOD CENTER DR STE 710
VIENNA VA
22182-2451
US

IV. Provider business mailing address

8614 WESTWOOD CENTER DR STE 710
VIENNA VA
22182-2451
US

V. Phone/Fax

Practice location:
  • Phone: 844-863-4621
  • Fax: 703-665-7686
Mailing address:
  • Phone: 844-863-4621
  • Fax: 703-665-7686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0709024863
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904020274
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: