Provider Demographics
NPI:1639284326
Name:BROKAW, EDITH LYNNE (LCSW, CSAC)
Entity Type:Individual
Prefix:MS
First Name:EDITH
Middle Name:LYNNE
Last Name:BROKAW
Suffix:
Gender:F
Credentials:LCSW, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44104 NATALIE TER
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-7901
Mailing Address - Country:US
Mailing Address - Phone:703-403-6944
Mailing Address - Fax:
Practice Address - Street 1:44081 PIPELINE PLZ
Practice Address - Street 2:#105
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5891
Practice Address - Country:US
Practice Address - Phone:703-403-6944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710102052101YA0400X
VA09040058001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)