Provider Demographics
NPI:1568932382
Name:SUTHERLAND, LILY REBECA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LILY
Middle Name:REBECA
Last Name:SUTHERLAND
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 1:1900 N BEAUREGARD ST STE 200
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311-1727
Mailing Address - Country:US
Mailing Address - Phone:703-746-6042
Mailing Address - Fax:
Practice Address - Street 1:1900 N BEAUREGARD ST STE 200
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-1727
Practice Address - Country:US
Practice Address - Phone:703-746-6042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040104051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical