Individual
JACQUELYNE M SMALLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
720 N SAINT ASAPH ST, ALEXANDRIA, VA 22314-1912
(703) 746-3485
(703) 838-5070
Mailing address
2205 N VAN DORN ST, APT. #303, ALEXANDRIA, VA 22304-1071
(703) 746-3485
(703) 838-5070
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
0810004112
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004945026
—
VA
Enumeration date
06/02/2009
Last updated
06/02/2009
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