Provider Demographics
NPI:1669681516
Name:PICKLE, KIRSTIN ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:KIRSTIN
Middle Name:ANN
Last Name:PICKLE
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 1:133 PARK ST NE
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4602
Mailing Address - Country:US
Mailing Address - Phone:703-281-2657
Mailing Address - Fax:
Practice Address - Street 1:133 PARK ST NE
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4602
Practice Address - Country:US
Practice Address - Phone:703-281-2657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040039591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical