| NPI | 1962789495 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAUREEN VICTORIA FANNIN Clinical Director/Owner 703-580-7210 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VA 1039-05-001) |
| Enumeration Date | 2011-11-11 |
| Last Update Date | 2011-11-11 |