Healthcare Provider Details

I. General information

NPI: 1568749372
Provider Name (Legal Business Name): ALICE L FORD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2011
Last Update Date: 11/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 W CHESAPEAKE AVE
TOWSON MD
21204-4421
US

IV. Provider business mailing address

8804 COPPERLEAF WAY
FAIRFAX STATION VA
22039
US

V. Phone/Fax

Practice location:
  • Phone: 410-828-6619
  • Fax:
Mailing address:
  • Phone: 571-277-2162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904002373
License Number StateVA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: