Healthcare Provider Details

I. General information

NPI: 1578628442
Provider Name (Legal Business Name): ALLYSON R. GARCIA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 N SAINT ASAPH ST
ALEXANDRIA VA
22314-1912
US

IV. Provider business mailing address

8459 RIPPLED CREEK CT
SPRINGFIELD VA
22153-3804
US

V. Phone/Fax

Practice location:
  • Phone: 703-838-6400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904003964
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: