Provider Demographics
NPI:1942728886
Name:ELLIE HSIEH, LMFT, LLC
Entity Type:Organization
Organization Name:ELLIE HSIEH, LMFT, LLC
Other - Org Name:ELLIE HSIEH, LMFT, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ELLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HSIEH
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:703-495-3203
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-30
Last Update Date:2017-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717001234106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0717001234OtherSTATE LICENSE NUMBER
12343421OtherCAQH NUMBER