Provider Demographics
NPI:1487275723
Name:NGUYEN, NHAT MINH (LCSW)
Entity type:Individual
Prefix:MR
First Name:NHAT
Middle Name:MINH
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8221 WILLOW OAKS CORPORATE DR # LL-401
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4512
Mailing Address - Country:US
Mailing Address - Phone:703-219-2561
Mailing Address - Fax:703-653-6683
Practice Address - Street 1:4213 WALNEY RD., CHANTILLY, 20151
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151
Practice Address - Country:US
Practice Address - Phone:571-536-9936
Practice Address - Fax:703-502-6683
Is Sole Proprietor?:No
Enumeration Date:2020-04-28
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040159491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0906009126OtherVIRGINIA BOARD OF SOCIAL WORK