Provider Demographics
NPI:1427254960
Name:INGLESE, VIRGINIA ELIZABITH (LCSW, RD)
Entity type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:ELIZABITH
Last Name:INGLESE
Suffix:
Gender:F
Credentials:LCSW, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 EAST ST. NE
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180
Mailing Address - Country:US
Mailing Address - Phone:703-255-7012
Mailing Address - Fax:703-255-6171
Practice Address - Street 1:169 EAST ST. NE
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180
Practice Address - Country:US
Practice Address - Phone:703-255-7012
Practice Address - Fax:703-255-6171
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040047881041C0700X
VAD00774133V00000X
VA000774133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered