Provider Demographics
NPI:1457801573
Name:CHU, CARISSA (LMFT)
Entity type:Individual
Prefix:
First Name:CARISSA
Middle Name:
Last Name:CHU
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6922 NETHERSTONE CT
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-3021
Mailing Address - Country:US
Mailing Address - Phone:703-999-2960
Mailing Address - Fax:
Practice Address - Street 1:7350 HERITAGE VILLAGE PLZ UNIT 102
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-3085
Practice Address - Country:US
Practice Address - Phone:571-295-5313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717001405106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist