Provider Demographics
NPI:1346614369
Name:LUNKIN-ELLIOTT, VIACHESLAV S (LCSW)
Entity Type:Individual
Prefix:MR
First Name:VIACHESLAV
Middle Name:S
Last Name:LUNKIN-ELLIOTT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 S QUAKER LN
Mailing Address - Street 2:SUITE 35
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-4585
Mailing Address - Country:US
Mailing Address - Phone:571-257-4398
Mailing Address - Fax:
Practice Address - Street 1:25 S QUAKER LN
Practice Address - Street 2:SUITE 35
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-4585
Practice Address - Country:US
Practice Address - Phone:571-257-4398
Practice Address - Fax:571-982-5967
Is Sole Proprietor?:No
Enumeration Date:2015-11-16
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA9040090641041C0700X
DCLC500807091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical