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Individual

JOELLE ANTONIA MACDONALD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LCSW

Contact information

Practice address
9870B MAIN ST, FAIRFAX, VA 22031-3908
(703) 869-8464
Mailing address
3502 LAUNCELOT WAY, ANNANDALE, VA 22003-1357
(703) 560-8129

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904002592
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
193715
ANTHEM BLUE CROSS
VA
01
M565-0002
CARE FIRST BLUE CROSS BLU
VA
Enumeration date
10/16/2006
Last updated
07/09/2007
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