Individual
MARY MOUSSA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC, CSAC
Contact information
Practice address
10560 MAIN ST STE 415, FAIRFAX, VA 22030-7174
(571) 318-6710
Mailing address
10560 MAIN ST STE 415, FAIRFAX, VA 22030-7174
(571) 318-6710
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
0710103429
VA
101YM0800X
Mental Health Counselor
Primary
0701009845
VA
Other
Enumeration date
04/21/2020
Last updated
09/20/2024
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