Provider Demographics
NPI:1164308821
Name:WHITE, LARISSA A (MFA, MA)
Entity type:Individual
Prefix:
First Name:LARISSA
Middle Name:A
Last Name:WHITE
Suffix:
Gender:F
Credentials:MFA, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8463 BROOK RD
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-1728
Mailing Address - Country:US
Mailing Address - Phone:703-994-3235
Mailing Address - Fax:
Practice Address - Street 1:6400 ARLINGTON BLVD STE 920
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-2336
Practice Address - Country:US
Practice Address - Phone:703-241-2664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health