Provider Demographics
NPI:1518592112
Name:ALTMIRE, ELAINE SULLIVAN (LPC)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:SULLIVAN
Last Name:ALTMIRE
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 1:1411 K ST NW STE 703
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20005-3435
Mailing Address - Country:US
Mailing Address - Phone:202-638-1992
Mailing Address - Fax:
Practice Address - Street 1:1701 CLARENDON BLVD STE 110
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22209-2700
Practice Address - Country:US
Practice Address - Phone:703-447-9263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008465101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional