Provider Demographics
NPI:1639247893
Name:SALTER, MARY CONSTANCE (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:CONSTANCE
Last Name:SALTER
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 1:7903 TURTLE CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-2200
Mailing Address - Country:US
Mailing Address - Phone:703-369-1465
Mailing Address - Fax:
Practice Address - Street 1:7903 TURTLE CREEK CIR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-2200
Practice Address - Country:US
Practice Address - Phone:703-369-1465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040006741041C0700X, 1041C0700X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist