Healthcare Provider Details

I. General information

NPI: 1578752648
Provider Name (Legal Business Name): DONNA KAY VANSICKLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 01/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 HOSPITAL DR
WARRENTON VA
20186-3006
US

IV. Provider business mailing address

600 EMILY LN
WINCHESTER VA
22602-7617
US

V. Phone/Fax

Practice location:
  • Phone: 540-347-7620
  • Fax: 540-349-0644
Mailing address:
  • Phone: 540-664-2511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904006468
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: