Provider Demographics
NPI:1861722159
Name:AMIRSADRI, AZADEH (MED, LMFT)
Entity type:Individual
Prefix:MS
First Name:AZADEH
Middle Name:
Last Name:AMIRSADRI
Suffix:
Gender:F
Credentials:MED, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6615 STONEPATH CIRCLE
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120
Mailing Address - Country:US
Mailing Address - Phone:703-502-4976
Mailing Address - Fax:
Practice Address - Street 1:8626 LEE HIGHWAY
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031
Practice Address - Country:US
Practice Address - Phone:703-205-0491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-08
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health