Provider Demographics
NPI:1639247893
Name:SALTER, CONSTANCE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:
Last Name:SALTER
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 1:8401 DORSEY CIR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:22110
Mailing Address - Country:US
Mailing Address - Phone:703-369-1465
Mailing Address - Fax:
Practice Address - Street 1:8401 DORSEY CIR
Practice Address - Street 2:SUITE 202
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-8303
Practice Address - Country:US
Practice Address - Phone:703-369-1465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
VA09040006741041C0700X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist