Provider Demographics
NPI:1144619917
Name:LOVETT, PHYLLIS MARIE (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:MARIE
Last Name:LOVETT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 POPLAR DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-1235
Mailing Address - Country:US
Mailing Address - Phone:703-338-4970
Mailing Address - Fax:
Practice Address - Street 1:4900 POPLAR DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-1235
Practice Address - Country:US
Practice Address - Phone:703-338-4970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-16
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040094731041C0700X
DCLC500808361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical