Healthcare Provider Details

I. General information

NPI: 1619282373
Provider Name (Legal Business Name): DANIELLE C CAUSLEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2010
Last Update Date: 09/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4031 UNIVERSITY DR STE 100
FAIRFAX VA
22030
US

IV. Provider business mailing address

PO BOX 11072
BURKE VA
22009-1072
US

V. Phone/Fax

Practice location:
  • Phone: 703-965-8712
  • Fax:
Mailing address:
  • Phone: 703-490-9681
  • Fax: 703-490-9682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904006801
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: