Provider Demographics
NPI:1326430109
Name:FARRAR, ELAINE DIANE (MA, LSWA, LPC)
Entity Type:Individual
Prefix:MISS
First Name:ELAINE
Middle Name:DIANE
Last Name:FARRAR
Suffix:
Gender:F
Credentials:MA, LSWA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 VALLEY PL SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-5715
Mailing Address - Country:US
Mailing Address - Phone:202-547-3870
Mailing Address - Fax:202-546-9642
Practice Address - Street 1:1327 VALLEY PL SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-5715
Practice Address - Country:US
Practice Address - Phone:202-547-3870
Practice Address - Fax:202-546-9642
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC1175101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCPRC1175Medicaid