Healthcare Provider Details

I. General information

NPI: 1962109272
Provider Name (Legal Business Name): LAUREN VICTORIA DICKINSON LCSW, MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN VICTORIA GRINDLE LCSW, MSW

II. Dates (important events)

Enumeration Date: 02/08/2023
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49480 YUKON DRIVE SUITE 206
ASHBURN VA
20147
US

IV. Provider business mailing address

10461 WHITE GRANITE DRIVE SUITE 210
OAKTON VA
22124
US

V. Phone/Fax

Practice location:
  • Phone: 703-723-3201
  • Fax: 703-729-2736
Mailing address:
  • Phone: 703-359-5160
  • Fax: 703-383-9574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904013820
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: