Healthcare Provider Details

I. General information

NPI: 1376518159
Provider Name (Legal Business Name): SHEILA GAIL REDMOND LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14450 SMOKETOWN RD
WOODBRIDGE VA
22192-4712
US

IV. Provider business mailing address

10208 HERON POND TER
BURKE VA
22015-3737
US

V. Phone/Fax

Practice location:
  • Phone: 703-576-1403
  • Fax: 703-576-1412
Mailing address:
  • Phone: 703-576-1403
  • Fax: 703-576-1412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number09040002445
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: