Provider Demographics
NPI:1841564713
Name:HSIEH, ELLIE (LMFT)
Entity Type:Individual
Prefix:
First Name:ELLIE
Middle Name:
Last Name:HSIEH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6924 FAIRFAX DR UNIT 416
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22213-1076
Mailing Address - Country:US
Mailing Address - Phone:703-495-3203
Mailing Address - Fax:
Practice Address - Street 1:43676 TRADE CENTER PL STE 135
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-2124
Practice Address - Country:US
Practice Address - Phone:703-495-3203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717001234106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0717001234OtherLICENSED MARRIAGE AND FAMILY THERAPIST