Provider Demographics
NPI:1063636090
Name:DOLINA, ELISSA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ELISSA
Middle Name:
Last Name:DOLINA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 WESTFORD CT
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22043-3429
Mailing Address - Country:US
Mailing Address - Phone:703-752-1599
Mailing Address - Fax:703-752-1599
Practice Address - Street 1:8320 PROFESSIONAL HILL DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4611
Practice Address - Country:US
Practice Address - Phone:703-876-8480
Practice Address - Fax:703-876-8482
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003503103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical