Provider Demographics
NPI:1790250934
Name:ALONGE, SHAUNA ELISE
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:ELISE
Last Name:ALONGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1881 N NASH ST UNIT 302
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22209-1562
Mailing Address - Country:US
Mailing Address - Phone:703-795-6188
Mailing Address - Fax:
Practice Address - Street 1:712 W BROAD ST
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3264
Practice Address - Country:US
Practice Address - Phone:703-795-6188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040106581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical