Provider Demographics
NPI:1639649551
Name:COLLINGRIDGE, ELISE KASSIE (LCSW)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:KASSIE
Last Name:COLLINGRIDGE
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 1:2120 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-5718
Mailing Address - Country:US
Mailing Address - Phone:703-228-5150
Mailing Address - Fax:703-228-5222
Practice Address - Street 1:2120 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-5718
Practice Address - Country:US
Practice Address - Phone:703-228-5150
Practice Address - Fax:703-228-5222
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040107811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical