Healthcare Provider Details

I. General information

NPI: 1043861511
Provider Name (Legal Business Name): BRITTANY BAILEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2019
Last Update Date: 02/24/2023
Certification Date: 02/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43130 AMBERWOOD PLZ STE 140
SOUTH RIDING VA
20152-4107
US

IV. Provider business mailing address

43130 AMBERWOOD PLZ STE 140
SOUTH RIDING VA
20152-4107
US

V. Phone/Fax

Practice location:
  • Phone: 703-348-0030
  • Fax: 703-542-7770
Mailing address:
  • Phone: 703-348-0030
  • Fax: 703-542-7770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904011281
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: