Provider Demographics
NPI:1477267482
Name:DOYLE, LARA (LCSW)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:
Last Name:DOYLE
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 1:405 N WASHINGTON ST STE 102
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-3410
Mailing Address - Country:US
Mailing Address - Phone:703-966-7185
Mailing Address - Fax:
Practice Address - Street 1:405 N WASHINGTON ST STE 102
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3410
Practice Address - Country:US
Practice Address - Phone:703-966-7185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVA09040061151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical