Provider Demographics
NPI:1669700191
Name:DESHAZIOR, JUANITA (LPC)
Entity type:Individual
Prefix:MS
First Name:JUANITA
Middle Name:
Last Name:DESHAZIOR
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 1:5300 HOLMES RUN PKWY
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-2834
Mailing Address - Country:US
Mailing Address - Phone:703-901-5592
Mailing Address - Fax:571-257-5551
Practice Address - Street 1:1301 L'ENFANT SQUARE, SE
Practice Address - Street 2:ALERNATIVE SOLUTIONS FOR YOUTH
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020
Practice Address - Country:US
Practice Address - Phone:202-584-1244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-20
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC219194101YM0800X
DCPRC14035101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health