Provider Demographics
NPI:1891320701
Name:DZULA, ELIZABETH WITHERS (MSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:WITHERS
Last Name:DZULA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8179 JAMES MADISON PKWY
Mailing Address - Street 2:
Mailing Address - City:KING GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:22485-5110
Mailing Address - Country:US
Mailing Address - Phone:540-775-2331
Mailing Address - Fax:
Practice Address - Street 1:8179 JAMES MADISON PKWY
Practice Address - Street 2:
Practice Address - City:KING GEORGE
Practice Address - State:VA
Practice Address - Zip Code:22485-5110
Practice Address - Country:US
Practice Address - Phone:540-775-2331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAPPS-06006481041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Single Specialty