Provider Demographics
NPI:1073254009
Name:AYASSO, SARA (MSED, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:AYASSO
Suffix:
Gender:F
Credentials:MSED, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 ANDERSON RD APT 201
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-1622
Mailing Address - Country:US
Mailing Address - Phone:412-378-2517
Mailing Address - Fax:
Practice Address - Street 1:9110 RAILROAD DR STE 310A
Practice Address - Street 2:
Practice Address - City:MANASSAS PARK
Practice Address - State:VA
Practice Address - Zip Code:20111-7042
Practice Address - Country:US
Practice Address - Phone:703-334-2206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701011357101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional