Provider Demographics
NPI:1255434411
Name:MUSSON, LAUREL H (LCSW)
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:H
Last Name:MUSSON
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 1:6452 WOODMERE PL
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-3931
Mailing Address - Country:US
Mailing Address - Phone:703-919-4394
Mailing Address - Fax:
Practice Address - Street 1:6452 WOODMERE PL
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20120-3931
Practice Address - Country:US
Practice Address - Phone:703-919-4394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040067461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical