Provider Demographics
NPI:1700356979
Name:ADIENG, ROZLYN
Entity Type:Individual
Prefix:MRS
First Name:ROZLYN
Middle Name:
Last Name:ADIENG
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ROZLYN
Other - Middle Name:
Other - Last Name:MALUAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1500 LINCOLN CIR APT 322
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-5853
Mailing Address - Country:US
Mailing Address - Phone:507-722-8188
Mailing Address - Fax:
Practice Address - Street 1:4875 EISENHOWER AVE STE 210
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-4833
Practice Address - Country:US
Practice Address - Phone:571-290-0143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-30
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician