Individual
JAIME JESUS HENAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CSAC
Contact information
Practice address
720 N SAINT ASAPH ST, ALEXANDRIA, VA 22314-1912
(703) 838-4455
Mailing address
5940 COVE LANDING RD, BURKE, VA 22015-4790
(703) 250-8766
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0710101709
VA
Other
Enumeration date
12/13/2006
Last updated
07/08/2007
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