Healthcare Provider Details

I. General information

NPI: 1124314364
Provider Name (Legal Business Name): PAMELA MARIE BEATON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PAMELA MARIE WALKER LCSW

II. Dates (important events)

Enumeration Date: 06/27/2011
Last Update Date: 12/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8140 ASHTON AVE SUITE 200
MANASSAS VA
20109-5698
US

IV. Provider business mailing address

8140 ASHTON AVE SUITE 200
MANASSAS VA
20109-5698
US

V. Phone/Fax

Practice location:
  • Phone: 703-330-9933
  • Fax: 703-368-8454
Mailing address:
  • Phone: 703-330-9933
  • Fax: 703-368-8454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904003768
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: