Provider Demographics
NPI:1356900476
Name:MADDEN, VIRGINIA LEE (LCPC)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:LEE
Last Name:MADDEN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6408 GROVEDALE DR STE 204
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-2596
Mailing Address - Country:US
Mailing Address - Phone:704-689-3395
Mailing Address - Fax:
Practice Address - Street 1:6408 GROVEDALE DR STE 204
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-2596
Practice Address - Country:US
Practice Address - Phone:571-543-3979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC12710101YM0800X
VA0704014643101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health