Provider Demographics
NPI:1700409075
Name:ARDITO, ALICEA (LCSW)
Entity Type:Individual
Prefix:
First Name:ALICEA
Middle Name:
Last Name:ARDITO
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 1:11611 HUNTERS GREEN CT
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-3505
Mailing Address - Country:US
Mailing Address - Phone:703-981-4265
Mailing Address - Fax:
Practice Address - Street 1:11611 HUNTERS GREEN CT
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-3505
Practice Address - Country:US
Practice Address - Phone:703-981-4265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-21
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040118081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical