Individual
SANDRA L DETTRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BSW CSAC
Contact information
Practice address
15D LOUDOUN ST SW, LEESBURG, VA 20175-2908
(703) 362-6682
Mailing address
15D LOUDOUN ST SW, LEESBURG, VA 20175-2908
(703) 362-6682
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0710000797
VA
Other
Enumeration date
11/20/2014
Last updated
11/20/2014
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