Provider Demographics
NPI:1003330275
Name:WARDEN, MARIETTA (MA, RN, CCS,CSAC,ADC)
Entity Type:Individual
Prefix:
First Name:MARIETTA
Middle Name:
Last Name:WARDEN
Suffix:
Gender:F
Credentials:MA, RN, CCS,CSAC,ADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4306 EVERGREEN LN STE 204
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-3217
Mailing Address - Country:US
Mailing Address - Phone:703-750-1292
Mailing Address - Fax:703-642-0859
Practice Address - Street 1:4306 EVERGREEN LN STE 204
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3217
Practice Address - Country:US
Practice Address - Phone:703-750-1292
Practice Address - Fax:703-642-0859
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001039438101YA0400X
VA0710101748101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)