Provider Demographics
NPI:1922701838
Name:FARISS, LETIZIA N/A
Entity Type:Individual
Prefix:
First Name:LETIZIA
Middle Name:N/A
Last Name:FARISS
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 1:3102 FLORAL PARK RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-9665
Mailing Address - Country:US
Mailing Address - Phone:301-292-2778
Mailing Address - Fax:
Practice Address - Street 1:700 W BRADDOCK RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-3601
Practice Address - Country:US
Practice Address - Phone:301-292-2778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-22
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP13713101YM0800X
VA0704015747101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health