Provider Demographics
NPI:1164694600
Name:LONG-FARIAS, RUTHANN EILEEN (LPC)
Entity Type:Individual
Prefix:
First Name:RUTHANN
Middle Name:EILEEN
Last Name:LONG-FARIAS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:
Other - Last Name:LONG-FARIAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:3615 CHAIN BRIDGE ROAD
Mailing Address - Street 2:UNIT I
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030
Mailing Address - Country:US
Mailing Address - Phone:703-385-9667
Mailing Address - Fax:
Practice Address - Street 1:3615 CHAIN BRIDGE ROAD
Practice Address - Street 2:UNIT I
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030
Practice Address - Country:US
Practice Address - Phone:703-385-9667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003791101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor