Provider Demographics
NPI:1730173667
Name:LINDQUIST, MARY LOU (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:MARY LOU
Middle Name:
Last Name:LINDQUIST
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 S YOAKUM PKWY
Mailing Address - Street 2:UNIT 11-14
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-4051
Mailing Address - Country:US
Mailing Address - Phone:703-461-8600
Mailing Address - Fax:703-461-7822
Practice Address - Street 1:205 S WHITING ST
Practice Address - Street 2:SUITE 402
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-7100
Practice Address - Country:US
Practice Address - Phone:703-461-8600
Practice Address - Fax:703-461-7822
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040023261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB7080001OtherCAREFIRST/BC/BS
VA491600Medicare ID - Type Unspecified
VAB708_0001OtherCAREFIRST/BC/BS