Provider Demographics
NPI:1588290118
Name:CISLO, MELANIE (LPC)
Entity type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:
Last Name:CISLO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:MELANIE
Other - Middle Name:ROSE
Other - Last Name:HUGHES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:9837 CHESHIRE RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-2791
Mailing Address - Country:US
Mailing Address - Phone:703-577-4326
Mailing Address - Fax:703-653-7002
Practice Address - Street 1:8221 WILLOW OAKS CORPORATE DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4512
Practice Address - Country:US
Practice Address - Phone:703-207-7777
Practice Address - Fax:703-653-7002
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-16
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0701008997101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional