Provider Demographics
NPI:1396021168
Name:BALICK, JAMES G (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:G
Last Name:BALICK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:JIM
Other - Middle Name:
Other - Last Name:BALICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:2505 KEY BLVD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-4021
Mailing Address - Country:US
Mailing Address - Phone:703-525-1555
Mailing Address - Fax:
Practice Address - Street 1:8221 WILLOW OAKS CORPORATE DR # 4420
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4512
Practice Address - Country:US
Practice Address - Phone:571-623-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040027581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical