Provider Demographics
NPI:1548666225
Name:WIDENER, ANMARIE (LCSW-C)
Entity type:Individual
Prefix:DR
First Name:ANMARIE
Middle Name:
Last Name:WIDENER
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 WEANT DR
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:22066-4132
Mailing Address - Country:US
Mailing Address - Phone:703-624-2202
Mailing Address - Fax:
Practice Address - Street 1:1316 MACBETH ST
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-2737
Practice Address - Country:US
Practice Address - Phone:703-624-2202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-07
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD198401041C0700X
VA09040087211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical