Provider Demographics
NPI:1134142748
Name:HAROLD, KATHLEEN ELEANORE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:ELEANORE
Last Name:HAROLD
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 1:3319 WEBLEY CT
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-1147
Mailing Address - Country:US
Mailing Address - Phone:703-534-9253
Mailing Address - Fax:
Practice Address - Street 1:107 N VIRGINIA AVE
Practice Address - Street 2:SUITE U-1
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3336
Practice Address - Country:US
Practice Address - Phone:703-534-9253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710000137101YA0400X
VA09040021321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical