| NPI | 1619415817 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLIE ERIN STELLJES NANSON Director 703-677-8633 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810005240) |
| Enumeration Date | 2017-02-08 |
| Last Update Date | 2017-02-08 |