Provider Demographics
NPI:1245849348
Name:GLIDEWELL, JAMIE ANNE (LICSW, LCSW-C, APHSW)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:ANNE
Last Name:GLIDEWELL
Suffix:
Gender:F
Credentials:LICSW, LCSW-C, APHSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1069 W BROAD ST
Mailing Address - Street 2:STE 804
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-4610
Mailing Address - Country:US
Mailing Address - Phone:703-923-8965
Mailing Address - Fax:844-496-1408
Practice Address - Street 1:10722 TENBROOK DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-1032
Practice Address - Country:US
Practice Address - Phone:970-231-4531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-24
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21646101YM0800X
DCLC50082273101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD21646OtherLCSW-C
DCLC50082273OtherLICSW
MDG-434-366-067-341OtherDRIVER'S LICENSE