Provider Demographics
NPI:1629379722
Name:WARREN, IHSAN J (LCSW)
Entity Type:Individual
Prefix:
First Name:IHSAN
Middle Name:J
Last Name:WARREN
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 1:440 MONTICELLO AVE
Mailing Address - Street 2:SUITE 1802 638348
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510
Mailing Address - Country:US
Mailing Address - Phone:202-930-2770
Mailing Address - Fax:
Practice Address - Street 1:5290 SHAWNEE RD STE 103
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-2381
Practice Address - Country:US
Practice Address - Phone:202-930-2770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-05
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040074981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical