Healthcare Provider Details

I. General information

NPI: 1417237033
Provider Name (Legal Business Name): HEATHER COLBY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2011
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8270 WILLOW OAKS CORPORATE DR
FAIRFAX VA
22031-4530
US

IV. Provider business mailing address

8270 WILLOW OAKS CORPORATE DR
FAIRFAX VA
22031-4530
US

V. Phone/Fax

Practice location:
  • Phone: 703-679-7735
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904007898
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number36102
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberPPS-0609199
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: