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General NPI Number Information
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NPI Number | 1932209921
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Entity Type | Individual
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Provider Name | CONNIE P EDENS LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 06/20/2024
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Provider Practice Location Address
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Address Line | 485 CARLISLE DR STE B
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City | HERNDON
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State | VA
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Zip | 20170
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Country | US
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Telephone | 571-306-2334
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Fax | 833-293-2987
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Provider Business Mailing Address
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Address Line | 11802 RIDERS LN
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City | RESTON
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State | VA
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Zip | 20191-4231
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Country | US
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Telephone | 571-306-2334
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Fax | 703-273-0148
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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 | 0904004723
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License Number State | VA
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