Provider Demographics
NPI:1336450519
Name:FREILICH, STACY (LCSW)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:
Last Name:FREILICH
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 1:25579 FALLING SPRING WAY
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20152-5717
Mailing Address - Country:US
Mailing Address - Phone:571-201-4048
Mailing Address - Fax:703-636-2622
Practice Address - Street 1:8082 CRESCENT PARK DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-3447
Practice Address - Country:US
Practice Address - Phone:540-727-0770
Practice Address - Fax:540-727-7310
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040073731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical