Provider Demographics
NPI:1225044258
Name:DESJARDINS, MARIE L (LCSW)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:L
Last Name:DESJARDINS
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 1:21641 RIDGETOP CIR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20166-6597
Mailing Address - Country:US
Mailing Address - Phone:571-258-3026
Mailing Address - Fax:571-258-3032
Practice Address - Street 1:801 CHILDRENS CENTER RD SW
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-2545
Practice Address - Country:US
Practice Address - Phone:703-777-3485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040048761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA195259OtherANTHEM PROVIDER NUMBER
VA254019OtherKAISER