1588290118 NPI number — MS. MELANIE CISLO LPC

Table of Contents

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:
12/19/2023
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: 101YP2500X , with the licence number:  0701008997 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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