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General NPI Number Information
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NPI Number | 1346876182
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Entity Type | Individual
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Provider Name | FERESHTEH KHODAEI SHAHROKHI LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/12/2020
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Last Update Date | 03/12/2020
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Provider Practice Location Address
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Address Line | LYNGATE CT SUITE 200
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City | BURKE
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State | VA
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Zip | 22015
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Country | US
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Telephone | 703-603-4882
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Fax | 703-532-7979
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Provider Business Mailing Address
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Address Line | 726 GOULDMAN LANE
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City | GREAT FALLS
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State | VA
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Zip | 22066
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Country | US
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Telephone | 703-442-3447
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Fax | 703-349-1132
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904003000
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License Number State | VA
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