Individual
KENDRA B OMISAKIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1651 OLD MEADOW RD STE 600, MC LEAN, VA 22102-4389
(703) 564-1639
Mailing address
1651 OLD MEADOW RD STE 600, MC LEAN, VA 22102-4389
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
06/08/2017
Last updated
06/08/2017
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