Healthcare Provider Details

I. General information

NPI: 1619537859
Provider Name (Legal Business Name): AMY DEAN WALKER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2019
Last Update Date: 06/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11230 WAPLES MILL RD STE 100
FAIRFAX VA
22030-6087
US

IV. Provider business mailing address

2352 SOFT WIND CT
RESTON VA
20191-4406
US

V. Phone/Fax

Practice location:
  • Phone: 703-591-1146
  • Fax: 703-591-1148
Mailing address:
  • Phone: 703-509-8612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904002250
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: