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General NPI Number Information
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NPI Number | 1629379722
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Entity Type | Individual
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Provider Name | IHSAN J WARREN LCSW
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Gender | Male
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Dates
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Enumeration Date | 11/05/2010
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Last Update Date | 03/04/2024
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Provider Practice Location Address
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Address Line | 5290 SHAWNEE RD STE 103
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City | ALEXANDRIA
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State | VA
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Zip | 22312-2381
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Country | US
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Telephone | 202-930-2770
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Fax |
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Provider Business Mailing Address
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Address Line | 440 MONTICELLO AVE SUITE 1802 638348
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City | NORFOLK
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State | VA
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Zip | 23510
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Country | US
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Telephone | 202-930-2770
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Fax |
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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 | 0904007498
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License Number State | VA
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