Provider Demographics
NPI:1114589991
Name:LOMAX, IVY TILLMAN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:IVY
Middle Name:TILLMAN
Last Name:LOMAX
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:IVY
Other - Middle Name:DENISE
Other - Last Name:TILLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:5559 SHERRY CT
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193
Mailing Address - Country:US
Mailing Address - Phone:571-316-1059
Mailing Address - Fax:
Practice Address - Street 1:12890 HARBOR DRIVE
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192
Practice Address - Country:US
Practice Address - Phone:571-316-1059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
VA09040080451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical