MEDICARE: MARY ANN SPROUSE LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	0904007003	VA

General Provider Information

NPI Number	:	1316182876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ANN SPROUSE LCSW

Provider Business Mailing Address
First Line	:	8440 OLD KEENE MILL RD
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22152-2302
Country	:	US
Telephone Number	:	709-569-1300
Fax Number	:

Provider Business Practice Location Address
First Line	:	8440 OLD KEENE MILL RD
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22152-2302
Country	:	US
Telephone Number	:	709-569-1300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2008
Last Update Date	:	06/03/2021

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