Provider Demographics
NPI:1679817548
Name:FRISTAD, JANICE LOUISE (LCSW, LGSW, CAE)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:LOUISE
Last Name:FRISTAD
Suffix:
Gender:F
Credentials:LCSW, LGSW, CAE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 MUSKET CT NE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-4805
Mailing Address - Country:US
Mailing Address - Phone:703-474-6202
Mailing Address - Fax:
Practice Address - Street 1:2 CARDINAL PARK DR SE STE 104A
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-4448
Practice Address - Country:US
Practice Address - Phone:703-980-9715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-16
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040079201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical