Provider Demographics
NPI:1083983704
Name:PATTI, COURTNEY ALLISON (LCSW-C)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ALLISON
Last Name:PATTI
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6004 BURDON COURT
Mailing Address - Street 2:APT 101
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315
Mailing Address - Country:US
Mailing Address - Phone:434-826-5293
Mailing Address - Fax:
Practice Address - Street 1:5980 9TH STREET
Practice Address - Street 2:BUILDING 1259
Practice Address - City:FT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060
Practice Address - Country:US
Practice Address - Phone:703-806-4252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-26
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD168711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical