Individual
KORD HALL BASNIGHT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RESIDENT IN COUNSELI
Contact information
Practice address
9525 OAK STREAM CT, FAIRFAX STATION, VA 22039-2650
(703) 861-6639
Mailing address
9525 OAK STREAM CT, FAIRFAX STATION, VA 22039-2650
(703) 861-6639
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
0704015863
VA
Other
Enumeration date
07/24/2023
Last updated
07/24/2023
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