Provider Demographics
NPI:1033689898
Name:LAL, VANESSA MACKALL
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:MACKALL
Last Name:LAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6905 VICTORIA DR UNIT C
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-4358
Mailing Address - Country:US
Mailing Address - Phone:703-409-0942
Mailing Address - Fax:
Practice Address - Street 1:2850 EISENHOWER AVE STE 310
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-4567
Practice Address - Country:US
Practice Address - Phone:844-947-3326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-04
Last Update Date:2022-10-19
Deactivation Date:2020-02-25
Deactivation Code:
Reactivation Date:2021-10-28
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health