Provider Demographics
NPI:1750830584
Name:ATTILLI, ANDREA LEIGH (LICSW)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:LEIGH
Last Name:ATTILLI
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3545 S STAFFORD ST
Mailing Address - Street 2:B1
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-1837
Mailing Address - Country:US
Mailing Address - Phone:202-486-0991
Mailing Address - Fax:
Practice Address - Street 1:3545 S STAFFORD ST
Practice Address - Street 2:B1
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22206-1837
Practice Address - Country:US
Practice Address - Phone:202-486-0991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500806221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical