Provider Demographics
NPI:1619415817
Name:LSN PSYCHOLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:LSN PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:ERIN
Authorized Official - Last Name:STELLJES NANSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:703-677-8633
Mailing Address - Street 1:11760 SUNRISE VALLEY DR
Mailing Address - Street 2:APT 814
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-1411
Mailing Address - Country:US
Mailing Address - Phone:703-677-8633
Mailing Address - Fax:
Practice Address - Street 1:1900 CAMPUS COMMONS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-1561
Practice Address - Country:US
Practice Address - Phone:703-677-8633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810005240103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty