Provider Demographics
NPI:1962911040
Name:MINTAAH, MAVIS (LCSW)
Entity type:Individual
Prefix:
First Name:MAVIS
Middle Name:
Last Name:MINTAAH
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 FETTLER PARK DR
Mailing Address - Street 2:
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22025-2050
Mailing Address - Country:US
Mailing Address - Phone:703-441-7680
Mailing Address - Fax:
Practice Address - Street 1:3700 FETTLER PARK DR
Practice Address - Street 2:
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22025-2050
Practice Address - Country:US
Practice Address - Phone:703-441-7680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-21
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
VA09040100701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical