Provider Demographics
NPI:1114763067
Name:ANUMUDU, CHIDERA B
Entity type:Individual
Prefix:
First Name:CHIDERA
Middle Name:B
Last Name:ANUMUDU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7376 ROUTE 29 UNIT 104
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-4766
Mailing Address - Country:US
Mailing Address - Phone:919-457-7150
Mailing Address - Fax:
Practice Address - Street 1:11835 HAZEL CIRCLE DR
Practice Address - Street 2:
Practice Address - City:BRISTOW
Practice Address - State:VA
Practice Address - Zip Code:20136-1223
Practice Address - Country:US
Practice Address - Phone:703-659-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040169761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical