Provider Demographics
NPI:1568809499
Name:MUSTAKOVA-POSSARDT, ELENA (EDD, LPC)
Entity Type:Individual
Prefix:DR
First Name:ELENA
Middle Name:
Last Name:MUSTAKOVA-POSSARDT
Suffix:
Gender:F
Credentials:EDD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4229 16TH ST S
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-4003
Mailing Address - Country:US
Mailing Address - Phone:703-380-1498
Mailing Address - Fax:
Practice Address - Street 1:4229 16TH ST S
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-4003
Practice Address - Country:US
Practice Address - Phone:703-380-1498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-02
Last Update Date:2013-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004435101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor