Individual
MR. LAHORE KHAN MANGAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RBT
Contact information
Practice address
1964 GALLOWS RD STE 302, VIENNA, VA 22182-3814
(703) 508-6162
Mailing address
12265 AZTEC PL, WOODBRIDGE, VA 22192-1817
(540) 764-8227
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-20-136359
VA
Other
Enumeration date
01/27/2021
Last updated
08/06/2024
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