Provider Demographics
NPI:1225037880
Name:WESTPHAL, CAROL ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:WESTPHAL
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 1:6015 FOX POINT RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-8356
Mailing Address - Country:US
Mailing Address - Phone:540-898-8844
Mailing Address - Fax:540-898-9436
Practice Address - Street 1:3516 PLANK RD
Practice Address - Street 2:SUITE 5C
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-6861
Practice Address - Country:US
Practice Address - Phone:540-786-3049
Practice Address - Fax:540-898-9436
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-17
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040053661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008953686Medicaid
VA008953686Medicaid
VAP87643Medicare UPIN