Provider Demographics
NPI:1245871771
Name:ZGANIACZ, ANNA MARIA (LCP)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:MARIA
Last Name:ZGANIACZ
Suffix:
Gender:F
Credentials:LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1659 FITZGERALD LN
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-2004
Mailing Address - Country:US
Mailing Address - Phone:571-201-2754
Mailing Address - Fax:
Practice Address - Street 1:3554 CHAIN BRIDGE RD STE 103
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2709
Practice Address - Country:US
Practice Address - Phone:703-896-7628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-06
Last Update Date:2019-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810006233103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical