Provider Demographics
NPI:1043532104
Name:GROSSMAN, LISA (LPC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:GROSSMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1831
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20108-1831
Mailing Address - Country:US
Mailing Address - Phone:703-393-7905
Mailing Address - Fax:703-393-9227
Practice Address - Street 1:8802 SUDLEY RD
Practice Address - Street 2:SUITE 112
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4736
Practice Address - Country:US
Practice Address - Phone:703-393-7905
Practice Address - Fax:703-393-9227
Is Sole Proprietor?:No
Enumeration Date:2010-02-17
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004776101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional