Provider Demographics
NPI:1932209921
Name:EDENS, CONNIE P (LCSW)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:P
Last Name:EDENS
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 1:11802 RIDERS LN
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-4231
Mailing Address - Country:US
Mailing Address - Phone:571-306-2334
Mailing Address - Fax:703-273-0148
Practice Address - Street 1:485 CARLISLE DR
Practice Address - Street 2:STE B
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170
Practice Address - Country:US
Practice Address - Phone:571-306-2334
Practice Address - Fax:833-293-2987
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040047231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA293481OtherAMERIGROUP
VA219059OtherANTHEM AT LEESBURG
VA219058OtherANTHEM AT ELMHC
VA000734L12Medicare ID - Type Unspecified