Provider Demographics
NPI:1912292962
Name:ROSS, CAROLYN 'CARLIE' FRENCH (LCSW)
Entity Type:Individual
Prefix:
First Name:CAROLYN 'CARLIE'
Middle Name:FRENCH
Last Name:ROSS
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 1:120 BEULAH RD NE
Mailing Address - Street 2:SUITE #201
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4745
Mailing Address - Country:US
Mailing Address - Phone:703-599-6808
Mailing Address - Fax:571-748-6623
Practice Address - Street 1:120 BEULAH RD NE
Practice Address - Street 2:SUITE #201
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4745
Practice Address - Country:US
Practice Address - Phone:703-599-6808
Practice Address - Fax:571-748-6623
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040074441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical