Individual
CLIFFORD J BLANC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1651 OLD MEADOW RD STE 600, MC LEAN, VA 22102-4389
(703) 564-1662
Mailing address
40 S VAN DORN ST APT D215, ALEXANDRIA, VA 22304-4214
(508) 818-1970
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-18-56593
VA
Other
Enumeration date
06/13/2018
Last updated
06/13/2018
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