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General NPI Number Information
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NPI Number | 1861722159
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Entity Type | Individual
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Provider Name | AZADEH AMIRSADRI M.ED, LMFT
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Gender | Female
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Dates
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Enumeration Date | 01/08/2010
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Last Update Date | 07/06/2011
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Provider Practice Location Address
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Address Line | 8626 LEE HIGHWAY
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City | FAIRFAX
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State | VA
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Zip | 22031
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Country | US
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Telephone | 703-205-0491
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Fax |
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Provider Business Mailing Address
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Address Line | 6615 STONEPATH CIRCLE
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City | CENTREVILLE
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State | VA
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Zip | 20120
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Country | US
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Telephone | 703-502-4976
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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