Individual
MRS. FERESHTEH KHODAEI SHAHROKHI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
LYNGATE CT, SUITE 200, BURKE, VA 22015
(703) 603-4882
(703) 532-7979
Mailing address
726 GOULDMAN LANE, GREAT FALLS, VA 22066
(703) 442-3447
(703) 349-1132
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904003000
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A62484544
DRIVER'S LICENSE
VA
Enumeration date
03/12/2020
Last updated
03/12/2020
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