Individual
MOLAR LISCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
10560 MAIN ST, FAIRFAX, VA 22030-7182
(571) 645-2222
Mailing address
41764, CYNTHIA TER, ALDIE, VA 20105
(571) 639-6091
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0704018085
VA
Other
Enumeration date
08/13/2025
Last updated
08/13/2025
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