Healthcare Provider Details

I. General information

NPI: 1447425970
Provider Name (Legal Business Name): PAMELA ANN THIELMANN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2008
Last Update Date: 04/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 S DINWIDDIE ST
ARLINGTON VA
22206-1037
US

IV. Provider business mailing address

2220 S DINWIDDIE ST
ARLINGTON VA
22206-1037
US

V. Phone/Fax

Practice location:
  • Phone: 703-931-8928
  • Fax:
Mailing address:
  • Phone: 703-931-8928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904005073
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: