Provider Demographics
NPI:1336946235
Name:YIASEMIDES, ELENI (MFCT)
Entity type:Individual
Prefix:
First Name:ELENI
Middle Name:
Last Name:YIASEMIDES
Suffix:
Gender:
Credentials:MFCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9452 MILL POND RD
Mailing Address - Street 2:
Mailing Address - City:SPOTSYLVANIA
Mailing Address - State:VA
Mailing Address - Zip Code:22551-3534
Mailing Address - Country:US
Mailing Address - Phone:540-760-4552
Mailing Address - Fax:
Practice Address - Street 1:150 OLDE GREENWICH DR STE 210
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-4002
Practice Address - Country:US
Practice Address - Phone:540-847-2876
Practice Address - Fax:540-371-4333
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0730000610106H00000X
VA0704014168101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist