Individual
CONNIE P EDENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
485 CARLISLE DR, STE B, HERNDON, VA 20170
(571) 306-2334
(833) 293-2987
Mailing address
11802 RIDERS LN, RESTON, VA 20191-4231
(571) 306-2334
(703) 273-0148
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904004723
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
219058
ANTHEM AT ELMHC
VA
01
—
219059
ANTHEM AT LEESBURG
VA
01
—
293481
AMERIGROUP
VA
Enumeration date
09/22/2006
Last updated
06/20/2024
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