Provider Demographics
NPI:1215694807
Name:LUDWIG, KYM (LCSW)
Entity type:Individual
Prefix:
First Name:KYM
Middle Name:
Last Name:LUDWIG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KYM
Other - Middle Name:
Other - Last Name:JOHANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15941 DONALD CURTIS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-4257
Mailing Address - Country:US
Mailing Address - Phone:703-792-7490
Mailing Address - Fax:703-792-5699
Practice Address - Street 1:15941 DONALD CURTIS DR STE 200
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-4257
Practice Address - Country:US
Practice Address - Phone:703-792-7490
Practice Address - Fax:703-792-5699
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040133641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical