1588290118 NPI number — MS. MELANIE CISLO LPC

Table of content: MS. MELANIE CISLO LPC (NPI 1588290118)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588290118 NPI number — MS. MELANIE CISLO LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CISLO
Provider First Name:
MELANIE
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HUGHES
Provider Other First Name:
MELANIE
Provider Other Middle Name:
ROSE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1588290118
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9837 CHESHIRE RIDGE CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANASSAS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20110-2791
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-577-4326
Provider Business Mailing Address Fax Number:
703-653-7002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8221 WILLOW OAKS CORPORATE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRFAX
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22031-4512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-207-7777
Provider Business Practice Location Address Fax Number:
703-653-7002
Provider Enumeration Date:
03/16/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  0701008997 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)