Provider Demographics
NPI:1225388762
Name:LUTTRELL, MEREDITH A (MA, LPC, LCPC)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:A
Last Name:LUTTRELL
Suffix:
Gender:F
Credentials:MA, LPC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 LEE HWY STE 130
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22209-1109
Mailing Address - Country:US
Mailing Address - Phone:757-403-1615
Mailing Address - Fax:
Practice Address - Street 1:1501 LEE HWY STE 130
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22209-1109
Practice Address - Country:US
Practice Address - Phone:757-403-1615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3920101YP2500X
VA0701007010101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional