Provider Demographics
NPI:1790808756
Name:ELKIN, LISA O (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:O
Last Name:ELKIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1491 CHAIN BRIDGE RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-5725
Mailing Address - Country:US
Mailing Address - Phone:571-238-6524
Mailing Address - Fax:
Practice Address - Street 1:1491 CHAIN BRIDGE RD
Practice Address - Street 2:SUITE 302
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-5725
Practice Address - Country:US
Practice Address - Phone:571-238-6524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003668103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical