Doctor Name: | MRS. IRENE CAROL ILACHINSKI |
NPI Number: | 1013047083 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | L.C.S.W. |
License Number: | 0904006259 |
Business Practice Address: | 12721 Darby Brook Ct Suite 102 Woodbridge, VA - 221922408 |
Business Phone Number: | 7034971771 |
Business Fax Number: | 7034971225 |
Mailing Address: | 8825 Newport Ct, SPRINGFIELD |
State: | VA |
Postal Code: | 221531218 |
Phone Number: | 7039123094 |
Fax Number: | 7033688454 |
NPI Enumeration Date: | 03/07/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 0904006259 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |