Provider Demographics
NPI:1265454169
Name:CONKLIN, PATRICIA B (LCSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:B
Last Name:CONKLIN
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 1:434 MITCHELL VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-6338
Mailing Address - Country:US
Mailing Address - Phone:276-783-7600
Mailing Address - Fax:276-783-1802
Practice Address - Street 1:434 MITCHELL VALLEY DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354-6338
Practice Address - Country:US
Practice Address - Phone:276-783-7600
Practice Address - Fax:276-783-1802
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040008651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008936081Medicaid
VA1265454169OtherNPI
R60981Medicare UPIN
800002850Medicare ID - Type Unspecified