Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 0001039438 | VA |
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 0710101748 | VA |
NPI | 1003330275 |
---|---|
Provider Name | Marietta Warden |
First Address | Annandale, VA 22003-3217 |
Second Address | Annandale, VA 22003-3217 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2017 |
Last Update Date | 31/07/2017 |