Provider Demographics
NPI:1255724936
Name:PHYLLIS MILLER PALOMBI MS, LMFT
Entity type:Organization
Organization Name:PHYLLIS MILLER PALOMBI MS, LMFT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:MILLER
Authorized Official - Last Name:PALOMBI
Authorized Official - Suffix:
Authorized Official - Credentials:MS,LPC, LMFT
Authorized Official - Phone:703-435-7686
Mailing Address - Street 1:11524 HEMINGWAY DR
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20194-1252
Mailing Address - Country:US
Mailing Address - Phone:703-435-7686
Mailing Address - Fax:703-563-9181
Practice Address - Street 1:11524 HEMINGWAY DR
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20194-1252
Practice Address - Country:US
Practice Address - Phone:703-435-7686
Practice Address - Fax:703-563-9181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001061261QM0850X
DCPRC13615261QM0850X
VA0717000212261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health