Provider Demographics
NPI:1487738365
Name:SHOAEE, ROKHSAREH SARAH
Entity type:Individual
Prefix:MRS
First Name:ROKHSAREH
Middle Name:SARAH
Last Name:SHOAEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:R
Other - Middle Name:SARAH
Other - Last Name:SHOAEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD MED LPC LMFT
Mailing Address - Street 1:8119 HOLLAND RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306
Mailing Address - Country:US
Mailing Address - Phone:703-360-6910
Mailing Address - Fax:703-360-0899
Practice Address - Street 1:8119 HOLLAND RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306
Practice Address - Country:US
Practice Address - Phone:703-360-6910
Practice Address - Fax:703-360-0899
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002446101YP2500X
VA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA32790001OtherBCB SHIELD