Provider Demographics
NPI:1356678809
Name:TIMMONS, MELINDA R (LMFT MS)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:R
Last Name:TIMMONS
Suffix:
Gender:F
Credentials:LMFT MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 N RANDOLPH ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207-3023
Mailing Address - Country:US
Mailing Address - Phone:808-781-3586
Mailing Address - Fax:
Practice Address - Street 1:1487 CHAIN BRIDGE RD
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-5723
Practice Address - Country:US
Practice Address - Phone:808-781-3586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-04
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717001434106H00000X
HI255106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty