Provider Demographics
NPI:1912224437
Name:RAY, LISA TUCKER (LCSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:TUCKER
Last Name:RAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:298 RILEY ST
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-3308
Mailing Address - Country:US
Mailing Address - Phone:703-400-7015
Mailing Address - Fax:
Practice Address - Street 1:6842 ELM ST
Practice Address - Street 2:SUITE 206
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3891
Practice Address - Country:US
Practice Address - Phone:703-400-7015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040024501041C0700X
DCLC3022931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical