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Individual

MRS. INGRID P BASURTO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
3919 BLENHEIM BLVD STE 83B, FAIRFAX, VA 22030-2430
(571) 559-2181
(571) 621-5708
Mailing address
1922 S WALTER REED DR, ARLINGTON, VA 22204-5113

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0704016140
VA

Other

Enumeration date
10/07/2024
Last updated
10/07/2024
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