Individual
MR. GEORGE A KOUSSOGLOU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
10128 HULL STREET RD, MIDLOTHIAN, VA 23112-3300
(804) 276-5761
(804) 745-3626
Mailing address
10128 HULL STREET RD, MIDLOTHIAN, VA 23112-3300
(804) 276-5761
(804) 745-3626
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904006093
VA
Other
Enumeration date
11/16/2006
Last updated
12/14/2009
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