Provider Demographics
NPI:1568678704
Name:DOUVILLE, BRIAN J (LCSW)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:J
Last Name:DOUVILLE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6073 ARLINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044-2721
Mailing Address - Country:US
Mailing Address - Phone:703-550-4048
Mailing Address - Fax:703-534-7163
Practice Address - Street 1:6073 ARLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-2721
Practice Address - Country:US
Practice Address - Phone:703-550-4048
Practice Address - Fax:703-534-7163
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040030051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC491689Medicare ID - Type Unspecified