Provider Demographics
NPI:1902228190
Name:RACINE, CECILIA (MSW)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:
Last Name:RACINE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3144 HOLLOWAY RD
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-4206
Mailing Address - Country:US
Mailing Address - Phone:202-486-9545
Mailing Address - Fax:
Practice Address - Street 1:3144 HOLLOWAY RD
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-4206
Practice Address - Country:US
Practice Address - Phone:202-486-9545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-08
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040070681041C0700X
MD146071041C0700X
DCLC500797491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical