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General NPI Number Information
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NPI Number | 1497830665
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Entity Type | Individual
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Provider Name | STEPHANIE CRADDOCK LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 06/29/2023
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Provider Practice Location Address
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Address Line | 26207 LANDS END DRIVE
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City | CHANTILLY
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State | VA
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Zip | 20152-5627
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Country | US
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Telephone | 732-266-6258
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Fax | 732-235-2408
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Provider Business Mailing Address
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Address Line | 26207 LANDS END DRIVE
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City | CHANTILLY
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State | VA
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Zip | 20152-5627
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Country | US
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Telephone | 732-266-6258
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Fax | 732-235-2408
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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 | 0904006829
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License Number State |
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