Provider Demographics
NPI:1376034629
Name:YEMANE, PETRINA ERMINIA
Entity Type:Individual
Prefix:
First Name:PETRINA
Middle Name:ERMINIA
Last Name:YEMANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 S WASHINGTON ST STE 303
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-2921
Mailing Address - Country:US
Mailing Address - Phone:646-421-5594
Mailing Address - Fax:703-462-9121
Practice Address - Street 1:150 S WASHINGTON ST STE 303
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-2921
Practice Address - Country:US
Practice Address - Phone:646-421-5594
Practice Address - Fax:703-462-9121
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007657101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health