Provider Demographics
NPI:1801083100
Name:MEDINA, CATHERINE ELIZABETH (LCSW)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ELIZABETH
Last Name:MEDINA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9407 CUMBERLAND RD
Mailing Address - Street 2:
Mailing Address - City:NEW KENT
Mailing Address - State:VA
Mailing Address - Zip Code:23124-2029
Mailing Address - Country:US
Mailing Address - Phone:800-368-3472
Mailing Address - Fax:804-966-5639
Practice Address - Street 1:9407 CUMBERLAND RD
Practice Address - Street 2:
Practice Address - City:NEW KENT
Practice Address - State:VA
Practice Address - Zip Code:23124-2029
Practice Address - Country:US
Practice Address - Phone:800-368-3472
Practice Address - Fax:804-966-5639
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040068531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004945018Medicaid