Provider Demographics
NPI:1962586156
Name:EPP, DIAN B (LCSW, CAC)
Entity type:Individual
Prefix:
First Name:DIAN
Middle Name:B
Last Name:EPP
Suffix:
Gender:F
Credentials:LCSW, CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10560 MAIN ST
Mailing Address - Street 2:SUITE 410
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-7182
Mailing Address - Country:US
Mailing Address - Phone:703-352-9007
Mailing Address - Fax:703-352-9040
Practice Address - Street 1:10560 MAIN ST
Practice Address - Street 2:SUITE 410
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-7182
Practice Address - Country:US
Practice Address - Phone:703-352-9007
Practice Address - Fax:703-352-9040
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA090400189091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
803193Medicare PIN