Provider Demographics
NPI:1518384130
Name:MONTANA, ALESIA WILLOW (LPC)
Entity Type:Individual
Prefix:MS
First Name:ALESIA
Middle Name:WILLOW
Last Name:MONTANA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 ARLINGTON BLVD APT 627
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-2778
Mailing Address - Country:US
Mailing Address - Phone:703-243-5074
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:4501 ARLINGTON BLVD APT 627
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-2778
Practice Address - Country:US
Practice Address - Phone:703-243-5074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-20
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003455101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional