Provider Demographics
NPI:1093177644
Name:MRINI, AUDRA IRENE (LPC)
Entity type:Individual
Prefix:MRS
First Name:AUDRA
Middle Name:IRENE
Last Name:MRINI
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 1:10375B DEMOCRACY LANE
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030
Mailing Address - Country:US
Mailing Address - Phone:703-639-8627
Mailing Address - Fax:703-821-2505
Practice Address - Street 1:10375B DEMOCRACY LANE
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030
Practice Address - Country:US
Practice Address - Phone:703-639-8627
Practice Address - Fax:703-821-2505
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-23
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X
VA0701007913101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral