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NPI Code Detail

MEDICARE: MARILYN STICKLE LCSW

MEDICARE: MARILYN STICKLE 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
1174400000XSpecialist0904000229VA

General Provider Information

NPI Number : 1780730408
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARILYN STICKLE LCSW
Provider Business Mailing Address
First Line : 5319 LEE HWY
Second Line :
City : ARLINGTON
State : VA
Zip : 22207-1607
Country : US
Telephone Number : 703-533-1038
Fax Number : 703-790-0232
Provider Business Practice Location Address
First Line : 5319 LEE HWY
Second Line :
City : ARLINGTON
State : VA
Zip : 22207-1607
Country : US
Telephone Number : 703-533-1038
Fax Number : 703-790-0232
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/26/2007
Last Update Date : 07/08/2007

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