Provider Demographics
NPI:1972369791
Name:LAGASSE, COLLEEN (LCSW)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:LAGASSE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:563 NALLS DAIRY CT
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:22066-1145
Mailing Address - Country:US
Mailing Address - Phone:571-444-3822
Mailing Address - Fax:
Practice Address - Street 1:11150 SUNSET HILLS RD STE 150
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5325
Practice Address - Country:US
Practice Address - Phone:571-306-0563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040164661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical