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General NPI Number Information
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NPI Number | 1093797060
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Entity Type | Individual
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Provider Name | KATIE R. EUSTICE LMSW-CC, CADC
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Gender | Female
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Dates
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Enumeration Date | 11/16/2005
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Last Update Date | 04/01/2024
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Provider Practice Location Address
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Address Line | 10084 DANIELS RUN WAY
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City | FAIRFAX
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State | VA
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Zip | 22030-2448
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Country | US
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Telephone | 303-902-0653
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Fax | 719-314-1719
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Provider Business Mailing Address
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Address Line | 10084 DANIELS RUN WAY
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City | FAIRFAX
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State | VA
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Zip | 22030-2448
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Country | US
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Telephone | 303-902-0653
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Fax | 719-314-1719
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 09924585
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License Number State | CO
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