Provider Demographics
NPI:1811921505
Name:FARIES, OLIVIA A (LCSW)
Entity type:Individual
Prefix:MS
First Name:OLIVIA
Middle Name:A
Last Name:FARIES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6718 PATTERSON AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3419
Mailing Address - Country:US
Mailing Address - Phone:804-282-5644
Mailing Address - Fax:804-673-2061
Practice Address - Street 1:6400 ARLINGTON BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-2325
Practice Address - Country:US
Practice Address - Phone:703-385-7600
Practice Address - Fax:703-385-7676
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040037521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010203783Medicaid