Provider Demographics
NPI:1174239081
Name:FREDERICK, FAREN (MSW,LMSW,MSPC)
Entity type:Individual
Prefix:MS
First Name:FAREN
Middle Name:
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:MSW,LMSW,MSPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 CHIMNEY HILL CT APT 102
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-7045
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14321 WINTER BREEZE DR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-2452
Practice Address - Country:US
Practice Address - Phone:833-452-9772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker