Provider Demographics
NPI:1124874540
Name:CARRODEGUAS, SOPHIA ELVIRA (LCSW)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:ELVIRA
Last Name:CARRODEGUAS
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 1:5581 HARRINGTON FALLS LN UNIT 1258
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-2599
Mailing Address - Country:US
Mailing Address - Phone:305-975-7585
Mailing Address - Fax:
Practice Address - Street 1:6400 ARLINGTON BLVD STE 200
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-2336
Practice Address - Country:US
Practice Address - Phone:305-975-7585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-26
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040165091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical