Provider Demographics
NPI:1972512572
Name:DENLINGER, GLEN M (LCSW)
Entity Type:Individual
Prefix:
First Name:GLEN
Middle Name:M
Last Name:DENLINGER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10401 NELLIE WHITE LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22032-3820
Mailing Address - Country:US
Mailing Address - Phone:703-919-3905
Mailing Address - Fax:
Practice Address - Street 1:10605 JUDICIAL DR STE A1
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-5116
Practice Address - Country:US
Practice Address - Phone:703-919-3905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLCSW 21791041C0700X
VA09040068271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ3770ZMedicare ID - Type Unspecified