Provider Demographics
NPI:1275981508
Name:ROBERTS, WILMA (LCSW)
Entity Type:Individual
Prefix:
First Name:WILMA
Middle Name:
Last Name:ROBERTS
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 1:4401 FORD AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-1473
Mailing Address - Country:US
Mailing Address - Phone:703-746-3507
Mailing Address - Fax:703-746-5975
Practice Address - Street 1:4401 FORD AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-1473
Practice Address - Country:US
Practice Address - Phone:703-746-3507
Practice Address - Fax:703-746-5975
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040085701041C0700X
FLSW 114141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical