Provider Demographics
NPI:1962192708
Name:JUDAH, EMILY KRYSTAL (LCSW)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:KRYSTAL
Last Name:JUDAH
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 1:11436 STILLBROOK RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23236-2410
Mailing Address - Country:US
Mailing Address - Phone:804-617-4396
Mailing Address - Fax:
Practice Address - Street 1:11436 STILLBROOK RD
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23236-2410
Practice Address - Country:US
Practice Address - Phone:804-617-4396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040152531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical