Provider Demographics
NPI:1609974278
Name:POGUE, GERALDINE B (LCSW)
Entity type:Individual
Prefix:MRS
First Name:GERALDINE
Middle Name:B
Last Name:POGUE
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 1:4721 TARPON LN
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22309-3142
Mailing Address - Country:US
Mailing Address - Phone:703-780-8737
Mailing Address - Fax:703-780-3230
Practice Address - Street 1:6020 RICHMOND HWY STE 200
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22303-2157
Practice Address - Country:US
Practice Address - Phone:703-960-7261
Practice Address - Fax:703-780-3230
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8906912Medicaid