Provider Demographics
NPI:1437453230
Name:THIEMAN, LAURA KRISTIN (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:KRISTIN
Last Name:THIEMAN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3611 CHAIN BRIDGE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-3246
Mailing Address - Country:US
Mailing Address - Phone:703-503-3646
Mailing Address - Fax:
Practice Address - Street 1:3611 CHAIN BRIDGE RD
Practice Address - Street 2:SUITE C
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-3246
Practice Address - Country:US
Practice Address - Phone:703-503-3646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040059771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical