Provider Demographics
NPI:1124230602
Name:TRECOSTA, LAUREN (LPC)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:
Last Name:TRECOSTA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5010 PORTSMOUTH ROAD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22032
Mailing Address - Country:US
Mailing Address - Phone:571-275-1423
Mailing Address - Fax:
Practice Address - Street 1:5417-C BACKLICK ROAD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22151
Practice Address - Country:US
Practice Address - Phone:571-275-1423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003258101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health