Provider Demographics
NPI:1104078765
Name:FLEISCH, HALLIE E (LCSW)
Entity type:Individual
Prefix:
First Name:HALLIE
Middle Name:E
Last Name:FLEISCH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:HALLIE
Other - Middle Name:E
Other - Last Name:WALLACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2757 S GLEBE RD
Mailing Address - Street 2:APT. 203
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-2727
Mailing Address - Country:US
Mailing Address - Phone:314-518-8715
Mailing Address - Fax:
Practice Address - Street 1:11230 WAPLES MILL RD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6087
Practice Address - Country:US
Practice Address - Phone:703-591-1146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-15
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20050026021041C0700X
FLSW93971041C0700X
VA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical