Provider Demographics
NPI:1184875031
Name:RATHBONE, CLARISSA REEVES (MED, LPC)
Entity type:Individual
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First Name:CLARISSA
Middle Name:REEVES
Last Name:RATHBONE
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6813 JEREMIAH CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX STATION
Mailing Address - State:VA
Mailing Address - Zip Code:22039-1834
Mailing Address - Country:US
Mailing Address - Phone:703-425-1434
Mailing Address - Fax:703-764-0516
Practice Address - Street 1:10560 MAIN ST
Practice Address - Street 2:STE 410
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-7182
Practice Address - Country:US
Practice Address - Phone:703-352-8900
Practice Address - Fax:703-352-9040
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0701004460101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional