Provider Demographics
NPI:1538987607
Name:D'AGOSTINO, MARIA GABRIELLA (LPC-R, ATR-P)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:GABRIELLA
Last Name:D'AGOSTINO
Suffix:
Gender:F
Credentials:LPC-R, ATR-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1485 CHAIN BRIDGE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-4501
Mailing Address - Country:US
Mailing Address - Phone:703-534-5100
Mailing Address - Fax:
Practice Address - Street 1:1485 CHAIN BRIDGE RD STE 300
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-4501
Practice Address - Country:US
Practice Address - Phone:703-534-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-28
Last Update Date:2024-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA24-802221700000X
VA0704017347101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist