Provider Demographics
NPI:1952978876
Name:FORDHAM, KATHERINE JAMISON (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:JAMISON
Last Name:FORDHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:JAMISON ARMSTRONG
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11814 CHESTER RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-1711
Mailing Address - Country:US
Mailing Address - Phone:804-318-8268
Mailing Address - Fax:
Practice Address - Street 1:11814 CHESTER RD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-1711
Practice Address - Country:US
Practice Address - Phone:804-318-8268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040123841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0904012384OtherCOMMONWEALTH OF VIRGINIA DEPARTMENT OF HEALTH PROFESSIONS, BOARD OF SOCIAL WORK