Provider Demographics
NPI:1679392674
Name:ALLEN, MARIAH LU (LPC)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:LU
Last Name:ALLEN
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 1:11310 LINKS CT
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-4805
Mailing Address - Country:US
Mailing Address - Phone:801-791-8157
Mailing Address - Fax:
Practice Address - Street 1:2100 WASHINGTON BLVD FL 3
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-5717
Practice Address - Country:US
Practice Address - Phone:703-228-1099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701013884101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health