Provider Demographics
NPI:1922011295
Name:TUTWILER, LYDIA ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:ANN
Last Name:TUTWILER
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 1:12112 WAYLAND ST
Mailing Address - Street 2:
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124-2234
Mailing Address - Country:US
Mailing Address - Phone:703-758-9438
Mailing Address - Fax:
Practice Address - Street 1:1850 CAMERON GLEN DR STE 600
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3343
Practice Address - Country:US
Practice Address - Phone:703-481-4161
Practice Address - Fax:703-435-1961
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040061031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical