MEDICARE: SHARQUITA R DUDLEY LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	0904012014	VA

General Provider Information

NPI Number	:	1558989293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARQUITA R DUDLEY LCSW

Provider Business Mailing Address
First Line	:	17271 DARBY BROOKE COURT
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22192
Country	:	US
Telephone Number	:	804-221-7873
Fax Number	:

Provider Business Practice Location Address
First Line	:	12721 DARBY BROOK CT STE 102
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22192-2408
Country	:	US
Telephone Number	:	703-497-1771
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2020
Last Update Date	:	03/03/2026

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