# GINA PARK LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568981769
- **Authorized official:** GINA PARK (OWNER)
- **Authorized official phone:** (703) 332-1845

## Contact information

- **Practice address:** 10195 MAIN ST STE O, FAIRFAX, VA 22031-3415
- **Practice address phone:** (703) 332-1845
- **Mailing address:** 9068 ANDROMEDA DR, BURKE, VA 22015-3510

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | — | NULL | Yes |
| 1041C0700X | Clinical Social Worker | — | — | Yes |

## Other

- **Enumeration date:** 09/19/2017
- **Last updated:** 05/29/2025