Healthcare Provider Details

I. General information

NPI: 1588783278
Provider Name (Legal Business Name): TREONA D BATEMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3018 JAVIER RD
FAIRFAX VA
22031-4609
US

IV. Provider business mailing address

6300 ARDSLEY SQ APT. 304H
VIRGINIA BEACH VA
23464-3545
US

V. Phone/Fax

Practice location:
  • Phone: 703-204-9100
  • Fax: 703-204-9590
Mailing address:
  • Phone: 757-553-8523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904006505
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: