Provider Demographics
NPI:1245804707
Name:AL-MANSUR, RAFEE (LMFT)
Entity Type:Individual
Prefix:MR
First Name:RAFEE
Middle Name:
Last Name:AL-MANSUR
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1364 BEVERLY RD STE 303
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3644
Mailing Address - Country:US
Mailing Address - Phone:703-828-5189
Mailing Address - Fax:
Practice Address - Street 1:1364 BEVERLY RD STE 303
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3644
Practice Address - Country:US
Practice Address - Phone:703-828-5189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717001814106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist