Provider Demographics
NPI:1215276365
Name:BRISTOW, LORI (PHD)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:
Last Name:BRISTOW
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:A
Other - Last Name:BRISTOW, PHD, LLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:7600 LAKESIDE VILLAGE DR
Mailing Address - Street 2:UNIT D
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-7548
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6723 WHITTIER AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-4522
Practice Address - Country:US
Practice Address - Phone:703-477-0692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-10
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004605103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist