Individual
DR. KOLLEEN MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
13890 BRADDOCK ROAD, CENTREVILLE, VA 20121-2435
(703) 623-4406
Mailing address
13890 BRADDOCK ROAD, 312, CENTREVILLE, VA 20121
(703) 246-3487
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810002629
VA
Other
Enumeration date
10/04/2006
Last updated
07/08/2007
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