Individual
MS. EDITH LYNNE BROKAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, CSAC
Contact information
Practice address
44081 PIPELINE PLZ, #105, ASHBURN, VA 20147-5891
(703) 403-6944
Mailing address
44104 NATALIE TER, SUITE 102, ASHBURN, VA 20147-7901
(703) 403-6944
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
0710102052
VA
1041C0700X
Clinical Social Worker
Primary
0904005800
VA
Other
Enumeration date
08/20/2006
Last updated
08/08/2012
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