Provider Demographics
NPI:1184835266
Name:NESTOR, ALVA (LCSW)
Entity Type:Individual
Prefix:
First Name:ALVA
Middle Name:
Last Name:NESTOR
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:AL
Other - Middle Name:
Other - Last Name:NESTOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:5808 RIVER DR
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-4131
Mailing Address - Country:US
Mailing Address - Phone:703-922-0443
Mailing Address - Fax:
Practice Address - Street 1:5808 RIVER DR
Practice Address - Street 2:
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-4131
Practice Address - Country:US
Practice Address - Phone:703-922-0443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040000571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00A671F04Medicare PIN