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Organization
NURTURE CHILD AND FAMILY, PLLC
Active
Organization
NURTURE CHILD AND FAMILY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK STEVEN GARDNER LCSW (MEMBER)
(703) 341-5995
Entity
Organization
Contact information
Practice address
1319 VINCENT PL, MC LEAN, VA 22101-3615
(703) 341-5995
(703) 341-5995
Mailing address
1319 VINCENT PL, MC LEAN, VA 22101-3615
(703) 341-5995
(703) 341-5995
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
080003355
VA
1041C0700X
Clinical Social Worker
Primary
904005796
VA
Other
Enumeration date
03/17/2016
Last updated
03/17/2016
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