Provider Demographics
NPI:1447209176
Name:CONLON, SALLY OWEN (LCSW)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:OWEN
Last Name:CONLON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:ELIZABETH
Other - Last Name:OWEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1129 RUGBY RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24503-2621
Mailing Address - Country:US
Mailing Address - Phone:434-386-3279
Mailing Address - Fax:
Practice Address - Street 1:1129 RUGBY RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24503-2621
Practice Address - Country:US
Practice Address - Phone:434-386-3279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040024131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA176482OtherANTHEM
VA176482OtherANTHEM