Provider Demographics
NPI:1285081091
Name:KNAKE, ELIZABETH (PSYD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:KNAKE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:HOLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3815 WARREN ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-2234
Mailing Address - Country:US
Mailing Address - Phone:610-812-1288
Mailing Address - Fax:
Practice Address - Street 1:5691 COLUMBIA PIKE
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041-2887
Practice Address - Country:US
Practice Address - Phone:703-998-5606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-22
Last Update Date:2016-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1001042103T00000X
VA0810004942103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist