Provider Demographics
NPI:1053925511
Name:THOMPSON, DANA CHRISTENSEN (LCSW)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:CHRISTENSEN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14215 ROCK CANYON DR
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-3806
Mailing Address - Country:US
Mailing Address - Phone:248-425-3775
Mailing Address - Fax:
Practice Address - Street 1:11260 ROGER BACON DR STE 206
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5252
Practice Address - Country:US
Practice Address - Phone:248-425-3775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040114451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical