Provider Demographics
NPI:1013246511
Name:OWEN, MARY CAROL (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:CAROL
Last Name:OWEN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8136 OLD KEENE MILL RD
Mailing Address - Street 2:SUITE 209-A
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-1850
Mailing Address - Country:US
Mailing Address - Phone:703-644-2361
Mailing Address - Fax:703-913-8563
Practice Address - Street 1:8136 OLD KEENE MILL RD
Practice Address - Street 2:SUITE 209-A
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-1850
Practice Address - Country:US
Practice Address - Phone:703-644-2361
Practice Address - Fax:703-913-8563
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-11
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040013331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical