Provider Demographics
NPI:1811095367
Name:RATLIFF, JUDITH HELENE (LCSW MSW)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:HELENE
Last Name:RATLIFF
Suffix:
Gender:F
Credentials:LCSW MSW
Other - Prefix:MISS
Other - First Name:JUDITH
Other - Middle Name:HELENE
Other - Last Name:FINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW LCSWC
Mailing Address - Street 1:2155 GOLF COURSE DRIVE
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-3834
Mailing Address - Country:US
Mailing Address - Phone:703-758-1660
Mailing Address - Fax:703-716-5410
Practice Address - Street 1:3700 JOSEPH SIEWICK DRIVE
Practice Address - Street 2:SUITE 402
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033
Practice Address - Country:US
Practice Address - Phone:703-758-1660
Practice Address - Fax:703-758-1660
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040014281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
869570Medicare ID - Type Unspecified