Healthcare Provider Details

I. General information

NPI: 1336566777
Provider Name (Legal Business Name): DEBORAH MARIE BUMBAUGH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2014
Last Update Date: 10/13/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 FAIRVIEW PARK DR STE 240
FALLS CHURCH VA
22042-4569
US

IV. Provider business mailing address

6624 COLTON CRAWFORD CIR APT 305
FALLS CHURCH VA
22042-6655
US

V. Phone/Fax

Practice location:
  • Phone: 703-228-1600
  • Fax: 703-228-1117
Mailing address:
  • Phone: 410-960-8833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904008121
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: