Provider Demographics
NPI:1336709930
Name:HADEED, VALERIE GAYLE (LLC, CSAC)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:GAYLE
Last Name:HADEED
Suffix:
Gender:F
Credentials:LLC, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3929 OLD LEE HWY
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2421
Mailing Address - Country:US
Mailing Address - Phone:703-409-2101
Mailing Address - Fax:
Practice Address - Street 1:3929 OLD LEE HWY STE 92C
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2421
Practice Address - Country:US
Practice Address - Phone:703-409-2101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008295101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health