METKEL B RUSSOM

FAIRFAX, VA
NPI1861292849
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy101YM0800X Counselor, Mental Health
Enumeration Date2025-03-18
Last Update Date2025-03-18
Business Address
METKEL B RUSSOM
10301 DEMOCRACY LN STE 302
FAIRFAX, VA 22030-2545
Phone number: 571-223-7588
Mailing Address
METKEL B RUSSOM
7115 HIGHLAND ST
SPRINGFIELD, VA 22150-3631
Phone number:
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