Individual
GABRIELLA T JACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NCC, LPC
Contact information
Practice address
9301 SANTAYANA DR, FAIRFAX, VA 22031-3069
(571) 502-8362
Mailing address
9301 SANTAYANA DR, FAIRFAX, VA 22031-3069
(571) 502-8362
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0701010212
VA
Other
Enumeration date
02/18/2021
Last updated
02/18/2021
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