Provider Demographics
NPI:1629625694
Name:HARNEY, SALLY (LPC)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:HARNEY
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 1:11166 FAIRFAX BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-5017
Mailing Address - Country:US
Mailing Address - Phone:703-988-4236
Mailing Address - Fax:703-721-7598
Practice Address - Street 1:11166 FAIRFAX BLVD STE 201
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-5017
Practice Address - Country:US
Practice Address - Phone:703-988-4236
Practice Address - Fax:703-721-7598
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-23
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704011722101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor