Provider Demographics
NPI:1558971549
Name:BROADUS-DUCKWORTH, ALICIA (LCSW)
Entity type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:
Last Name:BROADUS-DUCKWORTH
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6310 STILL SPRING PL
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-5593
Mailing Address - Country:US
Mailing Address - Phone:910-257-3278
Mailing Address - Fax:
Practice Address - Street 1:6310 STILL SPRING PL
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-5593
Practice Address - Country:US
Practice Address - Phone:910-257-3278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-04
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0119801041C0700X
VA09040159081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical