Provider Demographics
NPI:1295949410
Name:EDGE, ANNE DUVAL (LCSW)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:DUVAL
Last Name:EDGE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12801 IRON BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-1669
Mailing Address - Country:US
Mailing Address - Phone:804-768-0295
Mailing Address - Fax:804-717-5269
Practice Address - Street 1:1133 JEFFERSON GREEN CIR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-4300
Practice Address - Country:US
Practice Address - Phone:804-794-7777
Practice Address - Fax:804-794-7281
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040022061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8904421Medicaid