Basic Information
| Provider Information | |||||||||
| NPI: | 1174788244 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NEDRICK-ARMSTRONG | ||||||||
| FirstName: | CONSTANCE | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | NEDRICK | ||||||||
| OtherFirstName: | CONNIE | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LCSW | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 8119 BARD ST | ||||||||
| Address2: | |||||||||
| City: | MASON NECK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220793507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035413191 | ||||||||
| FaxNumber: | 7037925699 | ||||||||
| Practice Location | |||||||||
| Address1: | 8119 BARD ST | ||||||||
| Address2: | |||||||||
| City: | MASON NECK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220793507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035413191 | ||||||||
| FaxNumber: | 7037925699 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2008 | ||||||||
| LastUpdateDate: | 07/28/2008 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 0904003889 | VA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.