Provider Demographics
NPI:1548327315
Name:TYSON, DAVID SHELDON (LCSW, LCSW-C, LICSW)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:SHELDON
Last Name:TYSON
Suffix:
Gender:M
Credentials:LCSW, LCSW-C, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 TALAHI RD SE
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-5869
Mailing Address - Country:US
Mailing Address - Phone:202-957-8045
Mailing Address - Fax:574-975-8045
Practice Address - Street 1:402 TALAHI RD SE
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-5869
Practice Address - Country:US
Practice Address - Phone:202-957-8045
Practice Address - Fax:574-975-8045
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040064781041C0700X
MD154211041C0700X
DCLC500787661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical