Provider Demographics
NPI:1760582340
Name:DEBRA L. TIEVSKY, LCSW, PC
Entity Type:Organization
Organization Name:DEBRA L. TIEVSKY, LCSW, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:TIEVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:703-715-6011
Mailing Address - Street 1:5675 STONE RD
Mailing Address - Street 2:STE 300
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-1667
Mailing Address - Country:US
Mailing Address - Phone:703-715-6011
Mailing Address - Fax:703-991-9127
Practice Address - Street 1:5675 STONE RD
Practice Address - Street 2:STE 300
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20120-1667
Practice Address - Country:US
Practice Address - Phone:703-715-6011
Practice Address - Fax:703-991-9127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-24
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040017861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty