Provider Demographics
NPI:1952819492
Name:WULFF, ALISSA (LPC)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:
Last Name:WULFF
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12926 CEDAR GLEN LN
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-2951
Mailing Address - Country:US
Mailing Address - Phone:703-261-4696
Mailing Address - Fax:
Practice Address - Street 1:10400 EATON PL STE 420
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2208
Practice Address - Country:US
Practice Address - Phone:703-261-4696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-18
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007451101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional