Provider Demographics
NPI:1679041164
Name:NEIL, ELIZABETH (LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:NEIL
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4094 MAJESTIC LN # 237
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2104
Mailing Address - Country:US
Mailing Address - Phone:703-335-6172
Mailing Address - Fax:
Practice Address - Street 1:1205 DOLLEY MADISON BLVD
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3019
Practice Address - Country:US
Practice Address - Phone:703-335-6172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA070100848101YP2500X
VA071700137101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional