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General NPI Number Information
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NPI Number | 1578648978
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Entity Type | Individual
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Provider Name | ANA MARIA LASTRA ABROMAVAGE LPC
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Gender | Female
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7 BLOUDOUN ST., S.W. SUITE 220
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City | LEESBURG
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State | VA
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Zip | 20175
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Country | US
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Telephone | 703-708-8255
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Fax | 703-669-9129
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Provider Business Mailing Address
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Address Line | 43596 TUCKAWAY PL
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City | LEESBURG
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State | VA
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Zip | 20176-3993
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Country | US
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Telephone | 703-737-2161
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Fax | 703-669-9129
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701003302
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License Number State | VA
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