Provider Demographics
NPI:1033405212
Name:MALONE, LINDA DIANA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:DIANA
Last Name:MALONE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 TELESTAR CT
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-1206
Mailing Address - Country:US
Mailing Address - Phone:703-538-2165
Mailing Address - Fax:
Practice Address - Street 1:10530 LINDEN LAKE PLZ
Practice Address - Street 2:200
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-6434
Practice Address - Country:US
Practice Address - Phone:703-392-6707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-25
Last Update Date:2011-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040038021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical