Provider Demographics
NPI:1346876182
Name:SHAHROKHI, FERESHTEH KHODAEI (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:FERESHTEH
Middle Name:KHODAEI
Last Name:SHAHROKHI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:726 GOULDMAN LANE
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:22066
Mailing Address - Country:US
Mailing Address - Phone:703-442-3447
Mailing Address - Fax:703-349-1132
Practice Address - Street 1:LYNGATE CT
Practice Address - Street 2:SUITE 200
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015
Practice Address - Country:US
Practice Address - Phone:703-603-4882
Practice Address - Fax:703-532-7979
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-12
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040030001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAA62484544OtherDRIVER'S LICENSE