=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679648802
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SALLY F BIRD MSW LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/22/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 404 S GARFIELD ST
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-271-8529
-----------------------------------------------------
Fax | 703-271-0434
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 404 S GARFIELD ST
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-271-8529
-----------------------------------------------------
Fax | 703-271-0434
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 0904002075
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 0904002075
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------