Provider Demographics
NPI:1619034956
Name:PENLAND, MARGAUX RENE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARGAUX
Middle Name:RENE
Last Name:PENLAND
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARGAUX
Other - Middle Name:RENE
Other - Last Name:LAFORTUNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:233 PLEASANT ST SW
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-5618
Mailing Address - Country:US
Mailing Address - Phone:703-774-7412
Mailing Address - Fax:
Practice Address - Street 1:3300 GALLOWS RD
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-3300
Practice Address - Country:US
Practice Address - Phone:703-766-6563
Practice Address - Fax:703-776-7113
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0903001406101YM0800X
VA09040064491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health