Provider Demographics
NPI:1740340298
Name:CORDLE, TARA L (LPC)
Entity type:Individual
Prefix:MS
First Name:TARA
Middle Name:L
Last Name:CORDLE
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 1:3331 DUKE ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-4597
Mailing Address - Country:US
Mailing Address - Phone:703-370-2301
Mailing Address - Fax:703-370-2372
Practice Address - Street 1:3331 DUKE ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-4597
Practice Address - Country:US
Practice Address - Phone:703-370-2301
Practice Address - Fax:703-370-2372
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003677101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional