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General NPI Number Information
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NPI Number | 1548327315
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Entity Type | Individual
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Provider Name | DAVID SHELDON TYSON LCSW, LCSW-C, LICSW
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Gender | Male
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 03/15/2010
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Provider Practice Location Address
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Address Line | 402 TALAHI RD SE
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City | VIENNA
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State | VA
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Zip | 22180-5869
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Country | US
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Telephone | 202-957-8045
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Fax | 574-975-8045
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Provider Business Mailing Address
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Address Line | 402 TALAHI RD SE
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City | VIENNA
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State | VA
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Zip | 22180-5869
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Country | US
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Telephone | 202-957-8045
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Fax | 574-975-8045
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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 | 0904006478
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 15421
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LC50078766
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License Number State | DC
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