Provider Demographics
NPI:1336478171
Name:PAYNE, ANITA MARIE (LCSW)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:MARIE
Last Name:PAYNE
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 1:4819 EISENHOWER AVE STE B
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-4832
Mailing Address - Country:US
Mailing Address - Phone:804-221-5647
Mailing Address - Fax:
Practice Address - Street 1:4819 EISENHOWER AVE STE B
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-4832
Practice Address - Country:US
Practice Address - Phone:804-221-5647
Practice Address - Fax:703-664-0405
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-07
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040235681041C0700X
IL1490122601041C0700X
FLSW164571041C0700X
1041C0700X
VA09040074571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical