Provider Demographics
NPI:1164144283
Name:IMOH, MFRIE-EMEM IFIOK (LPC)
Entity type:Individual
Prefix:
First Name:MFRIE-EMEM
Middle Name:IFIOK
Last Name:IMOH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MFRIE
Other - Middle Name:
Other - Last Name:IMOH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RIC
Mailing Address - Street 1:5893 ANTHONY DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-3619
Mailing Address - Country:US
Mailing Address - Phone:703-730-0302
Mailing Address - Fax:703-730-0300
Practice Address - Street 1:11495 SUNSET HILLS RD STE 202
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5213
Practice Address - Country:US
Practice Address - Phone:703-935-0058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-15
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704014228101YM0800X
VA0701014402101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health