Provider Demographics
NPI:1437952801
Name:IMHOFF, MARYAM AZARI (LPC)
Entity type:Individual
Prefix:
First Name:MARYAM
Middle Name:AZARI
Last Name:IMHOFF
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:MARYAM
Other - Middle Name:AZARI
Other - Last Name:IMHOFF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:N/A
Mailing Address - Street 1:43482 GOLDEN MEADOW CIR
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5420
Mailing Address - Country:US
Mailing Address - Phone:703-223-6059
Mailing Address - Fax:
Practice Address - Street 1:43482 GOLDEN MEADOW CIR
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5420
Practice Address - Country:US
Practice Address - Phone:703-223-6059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701014708101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional