Provider Demographics
NPI:1578648978
Name:LASTRA ABROMAVAGE, ANA MARIA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ANA
Middle Name:MARIA
Last Name:LASTRA ABROMAVAGE
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 1:43596 TUCKAWAY PL
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-3993
Mailing Address - Country:US
Mailing Address - Phone:703-737-2161
Mailing Address - Fax:703-669-9129
Practice Address - Street 1:7 BLOUDOUN ST., S.W.
Practice Address - Street 2:SUITE 220
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175
Practice Address - Country:US
Practice Address - Phone:703-708-8255
Practice Address - Fax:703-669-9129
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003302101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA186334OtherANTHEM PROVIDER NUMBER