Provider Demographics
NPI:1922243757
Name:BOUDOUVAS-MANNOS, DEBBIE DESPINA (LCSW)
Entity Type:Individual
Prefix:
First Name:DEBBIE DESPINA
Middle Name:
Last Name:BOUDOUVAS-MANNOS
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 1:131 PARK ST NE
Mailing Address - Street 2:3RD FLOOR, SUITE B
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4641
Mailing Address - Country:US
Mailing Address - Phone:703-594-1479
Mailing Address - Fax:
Practice Address - Street 1:131 PARK ST NE
Practice Address - Street 2:3RD FLOOR, SUITE B
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4641
Practice Address - Country:US
Practice Address - Phone:703-594-1479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-08
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040067031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical