Provider Demographics
NPI:1598283384
Name:FRANCIS, CARISSA LARAY (LCSW)
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:LARAY
Last Name:FRANCIS
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 1:17333 PICKWICK DR STE C
Mailing Address - Street 2:
Mailing Address - City:PURCELLVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20132-6174
Mailing Address - Country:US
Mailing Address - Phone:814-977-9364
Mailing Address - Fax:
Practice Address - Street 1:17333 PICKWICK DR STE C
Practice Address - Street 2:
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-6174
Practice Address - Country:US
Practice Address - Phone:814-977-9364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-01
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040114221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty