Provider Demographics
NPI:1740263342
Name:HEALY, ELIZABETH ANNE (LCSW, CAC)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ANNE
Last Name:HEALY
Suffix:
Gender:F
Credentials:LCSW, CAC
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:ANNE
Other - Last Name:HEALY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, ADC, CCDP
Mailing Address - Street 1:6208 OLD FRANCONIA RD STE A
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-3406
Mailing Address - Country:US
Mailing Address - Phone:703-203-2385
Mailing Address - Fax:703-778-1069
Practice Address - Street 1:6208 OLD FRANCONIA RD
Practice Address - Street 2:STE A
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-3406
Practice Address - Country:US
Practice Address - Phone:703-203-2385
Practice Address - Fax:703-778-1069
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA89211101YA0400X
VA09040049101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0904004910OtherLICENSED CLINICAL SOCIAL WORKER