Provider Demographics
NPI:1932458171
Name:PULLEY, AYANNA MAIA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:AYANNA
Middle Name:MAIA
Last Name:PULLEY
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 1:2100 WASHINGTON BLVD
Mailing Address - Street 2:3RD FL.
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-5703
Mailing Address - Country:US
Mailing Address - Phone:703-228-1519
Mailing Address - Fax:703-228-1171
Practice Address - Street 1:2100 WASHINGTON BLVD
Practice Address - Street 2:3RD FL.
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-5703
Practice Address - Country:US
Practice Address - Phone:703-228-1519
Practice Address - Fax:703-228-1171
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-04
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040076871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical