Provider Demographics
NPI:1023272093
Name:MARCOLIN, PAULA LUCIA (LPC)
Entity type:Individual
Prefix:MS
First Name:PAULA
Middle Name:LUCIA
Last Name:MARCOLIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 LAKE SHORE CREST DR APT 4
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-3245
Mailing Address - Country:US
Mailing Address - Phone:301-437-4075
Mailing Address - Fax:
Practice Address - Street 1:459 CARLISLE DR STE B
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-5607
Practice Address - Country:US
Practice Address - Phone:571-323-1416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004387101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health