Provider Demographics
NPI:1538804588
Name:ELASSAL, TAMARA L (LPC, NCC)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:L
Last Name:ELASSAL
Suffix:
Gender:
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10560 MAIN ST STE 611
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-7114
Mailing Address - Country:US
Mailing Address - Phone:703-972-2120
Mailing Address - Fax:949-695-4194
Practice Address - Street 1:10560 MAIN ST STE 611
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-7114
Practice Address - Country:US
Practice Address - Phone:703-972-2120
Practice Address - Fax:949-695-4194
Is Sole Proprietor?:No
Enumeration Date:2022-05-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701011466101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor