Provider Demographics
NPI:1679925564
Name:PRUM, ANNA CAMPBELL (LCSW)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:CAMPBELL
Last Name:PRUM
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 1:2417 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-3203
Mailing Address - Country:US
Mailing Address - Phone:703-431-5148
Mailing Address - Fax:
Practice Address - Street 1:2300 MARTIN LUTHER KING JR AVE SE FL 5
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-5807
Practice Address - Country:US
Practice Address - Phone:202-528-5154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040093521041C0700X
DCLC500807131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical