Doctor Name: | MS. THERESE P. PHOTIADIS |
NPI Number: | 1316169642 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | 0904002275 |
Business Practice Address: | 1485 Chain Bridge Rd 204 Mclean, VA - 221014501 |
Business Phone Number: | 7037341477 |
Business Fax Number: | 7037346333 |
Mailing Address: | 1485 Chain Bridge Rd, 204 MCLEAN |
State: | VA |
Postal Code: | 221014501 |
Phone Number: | 7037341477 |
Fax Number: | 7037346333 |
NPI Enumeration Date: | 05/03/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 0904002275 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |