Provider Demographics
NPI:1174905756
Name:GIZACHEW, HIAWKAL (LCSW)
Entity type:Individual
Prefix:
First Name:HIAWKAL
Middle Name:
Last Name:GIZACHEW
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4529 SOUTHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-1621
Mailing Address - Country:US
Mailing Address - Phone:703-531-9325
Mailing Address - Fax:703-619-0045
Practice Address - Street 1:4529 SOUTHLAND AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-1621
Practice Address - Country:US
Practice Address - Phone:703-531-9325
Practice Address - Fax:703-619-0045
Is Sole Proprietor?:No
Enumeration Date:2015-06-19
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040090361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical