Provider Demographics
NPI:1922753474
Name:STRAKER, ALICE WATSON
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:WATSON
Last Name:STRAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 STONECROP CT
Mailing Address - Street 2:
Mailing Address - City:LAKE FREDERICK
Mailing Address - State:VA
Mailing Address - Zip Code:22630-2189
Mailing Address - Country:US
Mailing Address - Phone:703-628-0539
Mailing Address - Fax:
Practice Address - Street 1:2100 WASHINGTON BLVD FL 4
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-5717
Practice Address - Country:US
Practice Address - Phone:703-628-0539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
VA09040063761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical