Individual
MR. JAMES ROBERT LIPPOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW-0904012388
Contact information
Practice address
115 BEULAH ROAD, NE, SUITE 200-B, VIENNA, VA 22180
(703) 255-7012
(703) 255-6171
Mailing address
169 EAST STREET, NE, VIENNA, VA 22180
(703) 919-1668
(703) 255-6171
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
090412388
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0904012388
LICENSED CLINICAL SOCIAL WORKER (LCSW)
VA
Enumeration date
12/07/2020
Last updated
12/07/2020
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