Provider Demographics
NPI:1669491528
Name:AASEN, SANDY KYONG (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SANDY
Middle Name:KYONG
Last Name:AASEN
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 1:3926 KATHRYN JEAN CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2742
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10617 JONES ST
Practice Address - Street 2:301B
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-7506
Practice Address - Country:US
Practice Address - Phone:703-786-4152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040050821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAN259OtherCAREFIRST
VA189718OtherANTHEM
VAN259OtherCAREFIRST