Individual provider Active NPI

Jacklyne M Abdulai, LCSW

  • Clinical Social Worker
  • Alexandria, VA
National Provider Identifier
1699508648
Registry record updated Aug 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
0904017298 Issued in VA
Practice address
8119 Holland Rd
Alexandria, VA 22306-3135
Phone
(703) 559-3000
NPI assigned
Aug 24, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 26, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 0904017298 VA Primary

Addresses

Primary practice location

8119 Holland Rd
Alexandria, VA 22306-3135

Mailing address

8119 Holland Rd
Alexandria, VA 22306-3135
Phone (703) 559-3000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240910000694 DC Practitioner - Clinical Social Worker 7214477850 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0904017298VAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Fairfax County, Virginia CurrentSince Aug 23, 2024 Accepting new patients

Locations

8119 Holland Rd
Alexandria, VA 22306
Phone (703) 360-6910

12011 Government Center Pkwy
Ste 836
Fairfax, VA 22035
Phone (703) 324-7017

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1724457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724630400000",
    "number": "1699508648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8119 HOLLAND RD",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223063135",
            "telephone_number": "703-559-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8119 HOLLAND RD",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223063135",
            "telephone_number": "703-559-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ABDULAI",
        "first_name": "JACKLYNE",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-08-24",
        "last_updated": "2024-08-26",
        "certification_date": "2024-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904017298",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Alexandria, VA

Sources for this page

Verify at the official NPI Registry.