Provider Demographics
NPI:1841025871
Name:VIT, MARTINA (MSW, QMHPC)
Entity type:Individual
Prefix:MRS
First Name:MARTINA
Middle Name:
Last Name:VIT
Suffix:
Gender:F
Credentials:MSW, QMHPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9114 TIFFANY PARK CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-2195
Mailing Address - Country:US
Mailing Address - Phone:734-355-4075
Mailing Address - Fax:
Practice Address - Street 1:108A S COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-3051
Practice Address - Country:US
Practice Address - Phone:703-963-4261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09060127981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical