Provider Demographics
NPI:1619666583
Name:PANAHI, SAMIN FREJA (LGMFT)
Entity Type:Individual
Prefix:
First Name:SAMIN
Middle Name:FREJA
Last Name:PANAHI
Suffix:
Gender:F
Credentials:LGMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:788 3RD ST
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-3239
Mailing Address - Country:US
Mailing Address - Phone:617-990-2543
Mailing Address - Fax:
Practice Address - Street 1:6931 ARLINGTON RD STE 440
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-5231
Practice Address - Country:US
Practice Address - Phone:240-424-5328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGM947106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist