Provider Demographics
NPI:1841910072
Name:MPRAS, EVDOXIA (MFT)
Entity type:Individual
Prefix:
First Name:EVDOXIA
Middle Name:
Last Name:MPRAS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7303 IVYCREST PL
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-1657
Mailing Address - Country:US
Mailing Address - Phone:703-826-4936
Mailing Address - Fax:
Practice Address - Street 1:11870 SUNRISE VALLEY DR STE 200
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-3303
Practice Address - Country:US
Practice Address - Phone:703-598-0036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0730000652106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist