Provider Demographics
NPI:1073114757
Name:SANTYMIRE, ALISON (RESIDENT LMFT)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:SANTYMIRE
Suffix:
Gender:F
Credentials:RESIDENT LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14807 RYDELL RD APT 103
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-4456
Mailing Address - Country:US
Mailing Address - Phone:703-609-8203
Mailing Address - Fax:
Practice Address - Street 1:10640 PAGE AVE
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4000
Practice Address - Country:US
Practice Address - Phone:703-310-7665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-08
Last Update Date:2020-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0730000591103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily