Healthcare Provider Details

I. General information

NPI: 1275660094
Provider Name (Legal Business Name): BEVERLY HUBBLE TAUKE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10372 DEMOCRACY LN
FAIRFAX VA
22030-2522
US

IV. Provider business mailing address

1405 GREENWOOD PL
ALEXANDRIA VA
22304-1604
US

V. Phone/Fax

Practice location:
  • Phone: 703-591-2551
  • Fax: 703-591-2563
Mailing address:
  • Phone: 703-823-8993
  • Fax: 703-823-8994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904004645
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: