Healthcare Provider Details

I. General information

NPI: 1508073974
Provider Name (Legal Business Name): HEIDE ROKNI M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 WELLINGTON RD
ALEXANDRIA VA
22302-2228
US

IV. Provider business mailing address

3120 WELLINGTON RD
ALEXANDRIA VA
22302-2228
US

V. Phone/Fax

Practice location:
  • Phone: 703-597-7943
  • Fax:
Mailing address:
  • Phone: 703-597-7943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904005890
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50077784
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: