Provider Demographics
NPI:1053195404
Name:CHEN, ANNIE (MS)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 FRANCIS AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-4203
Mailing Address - Country:US
Mailing Address - Phone:443-248-8805
Mailing Address - Fax:
Practice Address - Street 1:46175 WESTLAKE DR STE 410
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-5886
Practice Address - Country:US
Practice Address - Phone:703-951-6409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist