Provider Demographics
NPI:1174239685
Name:ODDOUX, MARY (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:ODDOUX
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:MAREE
Other - Middle Name:
Other - Last Name:ODDOUX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3930 WALNUT ST STE 250
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-4750
Mailing Address - Country:US
Mailing Address - Phone:703-878-3290
Mailing Address - Fax:
Practice Address - Street 1:3930 WALNUT ST STE 250
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4750
Practice Address - Country:US
Practice Address - Phone:703-878-3290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040146041041C0700X
VT08901349621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical