Provider Demographics
NPI:1467224022
Name:ROSS-SOHL, MALVONA PATREACE (LCSW)
Entity Type:Individual
Prefix:
First Name:MALVONA
Middle Name:PATREACE
Last Name:ROSS-SOHL
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 1:4000 CHAIN BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-4017
Mailing Address - Country:US
Mailing Address - Phone:703-383-8500
Mailing Address - Fax:
Practice Address - Street 1:950 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2393
Practice Address - Country:US
Practice Address - Phone:703-718-6631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-26
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040160711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical