Provider Demographics
NPI:1124671474
Name:FARRIS, ALLIE (EDS)
Entity type:Individual
Prefix:
First Name:ALLIE
Middle Name:
Last Name:FARRIS
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:832 N FREDERICK ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-1109
Mailing Address - Country:US
Mailing Address - Phone:816-868-4027
Mailing Address - Fax:
Practice Address - Street 1:8500 EXECUTIVE PARK AVE STE 204
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2253
Practice Address - Country:US
Practice Address - Phone:703-876-8480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool