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1174116248
GABRIELLA T JACK
FAIRFAX, VA
NPI
1174116248
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
101YM0800X Counselor, Mental Health
(Licence: VA 0701010212)
Enumeration Date
2021-02-18
Last Update Date
2021-02-18
Business Address
GABRIELLA T JACK NCC, LPC
9301 SANTAYANA DR
FAIRFAX, VA 22031-3069
Phone number: 571-502-8362
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Mailing Address
GABRIELLA T JACK NCC, LPC
9301 SANTAYANA DR
FAIRFAX, VA 22031-3069
Phone number: 571-502-8362
Copy
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