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General NPI Number Information
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NPI Number | 1760582340
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Entity Type | Organization
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Legal Business Name | DEBRA L. TIEVSKY, LCSW, PC
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Dates
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Enumeration Date | 09/24/2006
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Last Update Date | 04/14/2010
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Provider Practice Location Address
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Address Line | 5675 STONE RD STE 300
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City | CENTREVILLE
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State | VA
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Zip | 20120-1667
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Country | US
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Telephone | 703-715-6011
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Fax | 703-991-9127
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Provider Business Mailing Address
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Address Line | 5675 STONE RD STE 300
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City | CENTREVILLE
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State | VA
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Zip | 20120-1667
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Country | US
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Telephone | 703-715-6011
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Fax | 703-991-9127
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. DEBRA LEE TIEVSKY
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Credential | LCSW
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Telephone | 703-715-6011
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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 | 0904001786
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License Number State | VA
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