Provider Demographics
NPI:1306502745
Name:PITARQUE HEISHMAN, MARIA ALICIA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ALICIA
Last Name:PITARQUE HEISHMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2709 VIKING DR
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-2412
Mailing Address - Country:US
Mailing Address - Phone:703-216-4113
Mailing Address - Fax:
Practice Address - Street 1:3613 CHAIN BRIDGE RD STE D
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-3238
Practice Address - Country:US
Practice Address - Phone:703-397-8163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-10
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09030016921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical