Provider Demographics
NPI:1144746173
Name:CORUM, KARICIA (LCSW)
Entity Type:Individual
Prefix:
First Name:KARICIA
Middle Name:
Last Name:CORUM
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 1:6310 EAGLE RIDGE LN UNIT A
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-3938
Mailing Address - Country:US
Mailing Address - Phone:703-731-6764
Mailing Address - Fax:
Practice Address - Street 1:8348 TRAFORD LN STE 400
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-1650
Practice Address - Country:US
Practice Address - Phone:703-866-2131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-22
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
VA09040099661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical