Provider Demographics
NPI:1962594358
Name:BRISTOL, PAULA MARIE (LCSW CEAP)
Entity type:Individual
Prefix:MS
First Name:PAULA
Middle Name:MARIE
Last Name:BRISTOL
Suffix:
Gender:F
Credentials:LCSW CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 CHILDRENS CENTER RD
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175
Mailing Address - Country:US
Mailing Address - Phone:703-509-0264
Mailing Address - Fax:703-777-4887
Practice Address - Street 1:801 CHILDRENS CENTER RD
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175
Practice Address - Country:US
Practice Address - Phone:703-509-0264
Practice Address - Fax:703-777-4887
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040056621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
289735OtherANTHEM