Provider Demographics
NPI:1447336078
Name:KOTTLER, TERRY LEE (LCSW)
Entity type:Individual
Prefix:MS
First Name:TERRY
Middle Name:LEE
Last Name:KOTTLER
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 1:12200 WESTWOOD HILLS DR
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-1511
Mailing Address - Country:US
Mailing Address - Phone:703-860-1206
Mailing Address - Fax:703-860-1208
Practice Address - Street 1:12200 WESTWOOD HILLS DR
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-1511
Practice Address - Country:US
Practice Address - Phone:703-860-1206
Practice Address - Fax:703-860-1208
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040024611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical