Provider Demographics
NPI:1720269897
Name:VALIAVEEDU, LETHA (LPC)
Entity Type:Individual
Prefix:
First Name:LETHA
Middle Name:
Last Name:VALIAVEEDU
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 1:1320 VINCENT PL
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3614
Mailing Address - Country:US
Mailing Address - Phone:949-609-9557
Mailing Address - Fax:
Practice Address - Street 1:15802 ATHENS CT
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-1344
Practice Address - Country:US
Practice Address - Phone:949-609-9557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004333101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional