Provider Demographics
NPI:1457831364
Name:SOLIGAN, TARA DANIELLE (LPC, MAC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:DANIELLE
Last Name:SOLIGAN
Suffix:
Gender:F
Credentials:LPC, MAC, NCC
Other - Prefix:MISS
Other - First Name:TARA
Other - Middle Name:DANIELLE
Other - Last Name:NEIGENFIND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3321 MANTUA DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2712
Mailing Address - Country:US
Mailing Address - Phone:571-354-0113
Mailing Address - Fax:
Practice Address - Street 1:4023 CHAIN BRIDGE RD STE 7
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4121
Practice Address - Country:US
Practice Address - Phone:571-354-0113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005769101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional