Provider Demographics
NPI:1417125881
Name:TOENNIESSEN, CARLA SAMS (LMFT)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:SAMS
Last Name:TOENNIESSEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3718 RICHARD AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-3535
Mailing Address - Country:US
Mailing Address - Phone:703-863-2737
Mailing Address - Fax:
Practice Address - Street 1:513 MAPLE AVE W
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4238
Practice Address - Country:US
Practice Address - Phone:703-863-2737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717001147106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist