Provider Demographics
NPI:1851159099
Name:LUTZ, KATHERINE M (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:M
Last Name:LUTZ
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 1:44340 PREMIER PLZ STE 230
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5074
Mailing Address - Country:US
Mailing Address - Phone:703-646-7664
Mailing Address - Fax:
Practice Address - Street 1:44340 PREMIER PLZ STE 230
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5074
Practice Address - Country:US
Practice Address - Phone:703-646-7664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-12
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040164531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical