Provider Demographics
NPI:1972992386
Name:GARRISON, MELAINA NEYER (LMFT)
Entity type:Individual
Prefix:
First Name:MELAINA
Middle Name:NEYER
Last Name:GARRISON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11160-C1 SOUTH LAKES DR.
Mailing Address - Street 2:#144
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191
Mailing Address - Country:US
Mailing Address - Phone:571-377-8683
Mailing Address - Fax:859-578-3273
Practice Address - Street 1:11160-C1 SOUTH LAKES DR.
Practice Address - Street 2:#144
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191
Practice Address - Country:US
Practice Address - Phone:571-377-8683
Practice Address - Fax:859-578-3273
Is Sole Proprietor?:No
Enumeration Date:2015-01-22
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY240382106H00000X
VA0717001599106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY610661458OtherTAX ID